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Increasing Produce Consumption
At The Worksite

The Pundit extends congratulations to Curtis Granger, most recently with the Ripe ‘N Ready Tree Fruit, as he has accepted a new position as Program Manager at the Public Health Institute (PHI), Oakland, California. We asked Pundit Investigator and Special Projects Editor, Mira Slott, to talk with Curtis and the interview is very intriguing.

The produce industry’s 5-a-Day program has been mainly a promotional program — a brand if you will. But the Pundit has always wondered if the time and money wouldn’t be more effectively invested in specific efforts to boost consumption among certain population groups.

The most important thing to remember is that you can’t increase consumption in general without increasing consumption in particular. Put another way, people have to eat more of specific items at specific times in specific places.

This type of effort has been problematic for 5-a-Day because of political difficulties. It is hard to promote specific items, specific times and specific places because different products and different organizations have different interests.

What is interesting about the public health approach that Granger is now championing is that is combines a very specific effort to change behavior with a recognition that the public health benefits of increased produce consumption are not randomly distributed through the population. We can get better bang for the buck and help people more by focusing on certain “at risk” groups.

This program and others like it have real potential to boost business and improve public health. It is a chance for the industry to do well by doing good and is well worth paying attention to:

Program Manager at the
Public Health Institute (PHI)
Oakland, California

Witnessing huge gaps in produce distribution and consumption, 17-year produce industry veteran Curtis Granger has shifted over to the public health sector to advocate produce from another vantage point.

Granger will lead the statewide rollout of a California Department of Health Services (CDHS) Nutrition Worksite program. He jumps into his new role with hefty goals that are focused on California but have application across the United States and globally.

Granger is looking to buoy his extensive experience in the produce industry where he spearheaded innovative business development and marketing programs for Ripe ‘N Ready Tree Fruit, the Chilean Fresh Fruit Association and California Kiwifruit Commission. He also served as Chairman of the Produce for Better Health Foundation National 5-a-Day Program in 2003, and as a member of the California Nutrition Network/California 5-a-Day Executive Joint Steering Committee.

The Worksite initiative is part of a larger, multi-faceted program started within the California 5-a-Day for Better Health Campaign, which teams with local, state and national partners to increase produce distribution and consumption in tandem with physical activity in underserved communities across California. It is currently called the California 5-a-Day — Be Active! Worksite Program.

The worksite program is jointly funded through USDA Food Stamp Nutrition Education, with matching dollars from a vast 11-region local network of public health, nonprofits, private businesses, etc., according to Granger. Take Action, a 10-week plan, is the worksite program’s base template designed with produce and activity modules.

Currently, they are just completing pilots with six businesses, and the general feedback is that employee participation is above average, and employers are very encouraged about how a lifestyle and “stage of change” approach has engaged their employees.

The Take Action plan is web-based and has already been accessed by 40 countries just since May.

The USDA funding targets low-income employees, many of whom don’t have health insurance, to boost produce consumption and physical activity as a means to reduce risks of chronic diseases and other health problems. In addition, businesses may see benefits from improved health that positively affects company morale and job performance, lowering absenteeism, turnover, and disability days, while attacking burdensome medical costs.

According to Granger, once the employer gets an engaged employee to participate, the employer’s biometric measurements will be an effective tool to go back to their insurance provider and begin negotiating some reductions in premiums.

In the following interview, Granger shares his thoughts about his new role:

Q: What triggered you to jump outside the produce industry to work in the government arena? You seem highly ambitious in terms of what you hope to accomplish.

A: I haven’t left the produce industry. I’m trying to help take you guys to a new place. Produce executives need to step out of the box. We must carve out new approaches to address epidemic health issues and skyrocketing health care costs. We are missing a lot of opportunities by just focusing on the top five retailers. Everyone uses the same old channels. How many relationships have we overlooked?

The bottom line is for us to really impact health and lifestyle. We have to be as pervasive as Coke, Pepsi and McDonald’s, be everywhere they are and taste better consistently. That’s how we’ll drive produce consumption and overcome these health problems and better manage health care costs.

Q: How do you achieve these aspirations through Worksite and its sister programs? Government agencies have been known to be fraught with bureaucratic red tape.

A: This is not your traditional government agency; this is an active program. We need to do a better job of tying back to the industry, taking unconventional paths to increase access and consumption. This worksite program has been going well for a while in pilot form, yet the produce industry hasn’t been paying attention to it. The corporate channel we’re going into can afford produce.

But beyond that, I’m being given latitude within the organization to work with other program managers and the media. Food stamps pay for produce. That’s seven million customers. Terminal markets need to open their eyes a little and connect to WIC and food stamp programs. We need to link growers directly. We’re looking to talk to commodity boards to tie in to school retail programs.

Physical activity is a big part of this program. Produce companies should be connecting to organizations like parks, fitness clubs, you name it. If you look at NANA, the National Alliance of Nutrition and Physical Activity, there are a lot of partners, and I’m not sure we’ve leveraged these in the produce industry.

Q: Could you talk about the need for the work you’re undertaking?

A: Economic studies estimate that physical inactivity, obesity, and being overweight cost California more than $28 billion in direct and indirect medical care, workers’ compensation, and lost productivity costs annually, and that number is only increasing. The state budget is a pie and gets cut up for education infrastructure, etc. People don’t get the fact we have to provide the tools to change the environment we’re in. We have to create a system of motivation for self care. The precedent for change is dire in California, but the annual national impact is $259 billion in health care expenditures, medications, lost productivity and death.

Q: Who does the program target specifically and why?

A: Stipulated by the USDA, those within 185 percent of poverty level, roughly $34,000 annual income and under. The Nutrition Network has focused on populations where we find the most incidence of chronic disease. There is a disparity in health problems and rates of disease based on economic and ethnicity factors. For example, studies show that diabetes in African Americans is 2.9 times higher than in Caucasians, and 1.7 times higher in Latino populations, and when accounting for socioeconomic factors, the disparities widen.

Q: Are there other programs in the pipeline?

A: We are also piloting a new Asian/Pacific program, neighborhood and lingual specific, to really fit the culture, focused on reducing chronic disease by increasing fruits and vegetables and physical activity.

Q: For perspective, what percentage of people will Worksite affect? And are there long term goals of expanding the program?

A: With the launch of the program, we will be reaching at least 20,000 employees at 220 companies, many of which don’t provide health insurance. Targeting 11 regions, the statewide rollout will get underway between February and April, but pilots have already shown successful results. This is just the tip of the iceberg. We have to start somewhere and then scale. In California, roughly 5.5 million to 7 million are underserved in our demographic. That’s 18 percent of the state’s population. But our program can go anywhere. It’s available and others are testing it and finding it very effective.

Q: How unique is your program?

A: There are other programs with physical activity components but not one focused on increasing produce consumption at the worksite, certainly nothing wide scope like this. Studies of corporate wellness programs average 35 to 40 percent engagement, but our pilots show 66 percent participation.

Q: Why is that?

A: The strength of this program is that it’s an employee-driven, team-based approach. That’s where you see the most impact. In order to develop a total health program, first it is critical to build trust with employees, including their input in the design and execution, otherwise they won’t participate. Getting initial health risk assessments and tracking cholesterol and weight reductions can be challenging because employees are worried their companies will use the data for other purposes.

Different modules range from instituting a farmer’s market to adapting meals in the cafeteria following nutritional guidelines, to putting fresh produce in vending machines, to onsite physical activities. (See for more specific examples).

Q: What can the produce industry do to get involved?

A: Companies should be having conversations with corporate chief financial officers on how to reduce health care costs, offering intervention strategies to increase productivity. Produce suppliers all have relationships with distributors. The way I see the produce industry coming at this is through a different avenue. Instead of talking to the foodservice distributor, go to the company executive overseeing employee health.

To push more fruits and vegetables into the worksite environment, the discussion needs to come at a different level. The CFO is saying profitability is eroding and turns to the medical director or human resources/benefits director and asks how to get health care costs under control. Labor and training issues are a hot button, and here’s a way to attract and hold employees.

We can insert ourselves into the dialogue. The bottom line is that once they develop the program and get the health risk assessment done, the intervention program can begin to change the work environment and translate those behaviors back home.

Q: What challenges do you face? Especially in adults, eating habits are engrained. Aren’t long-term behaviors difficult to change?

A: Yes. That’s why our Nutrition Network’s Power Play program targets children up to 11 years old, the last time you really have a strong influence to change eating habits, and ideally it’s best to try and get through to kids earlier at age 5.

I look at Worksite as a bridge program. The percent of overweight or obese people has hit epidemic levels. There is a big push to put more of the health care cost burdens back on employees. And the message is negative all around. Companies institute a health promotion that is lifestyle-behavior based, employees own it, health risks are reduced, and it’s a win-win situation.

Q: Could your Worksite program link back to retailers?

A: We’re working on that right now. When retailers go to negotiate with unions, the big issues are health care costs and wages. Could you imagine the strides one could make by taking health care costs off the table? The program starts at the corporate headquarters. The challenge is making the program stick at the store level. Top down mandates don’t work. Employees have to own it.

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