Seattle and King County – Letter of Intent

W.K. Kellogg Foundation Food and Fitness Initiative

The Pacific Northwest is known for its livable communities, active lifestyles, rich agriculture and
technological innovation. Nevertheless, overweight and obesity prevalence are increasing, as
they are in the rest of the nation. King County, which encompasses both large urban centers such
as Seattle and Bellevue and small rural towns, is home to a number of initiatives that aim to
make it easier to eat well and live actively. Efforts are underway to shape our local food system
to support sustainable agriculture and provide fresh food to King County residents, especially
those in underserved communities. Last year, the King County Board of Health adopted a 10-
point plan with specific goals for promoting nutrition, increasing physical activity and improving
the built environment and land use to reduce overweight and obesity prevalence in our
population. With this foundation, we are poised to integrate these activities horizontally across
program areas and vertically across socio-ecologic levels. Efforts are also underway to eliminate
health disparities among racial, ethnic and low socioeconomic populations.
Participating in the Planning Phase of the Food and Fitness Initiative would allow coordination
of these broad-based community efforts into an integrated system. The creation of a
comprehensive community plan would leverage resources, facilitate partnerships and
significantly expand our community’s capacity for change.
Our primary goals for this Initiative are to:
1) Help build social environments that encourage healthy eating and physical activity.
2) Develop an integrated regional food system that supports local, sustainable agriculture.
3) Support built environments and land use that promote physical activity and environmental
sustainability.
4) Provide healthy, affordable, locally-produced foods, especially to marginalized communities.
5) Reduce socioeconomic disparities in overweight, poor nutrition and physical inactivity.
6) Engage youth and those most impacted by health disparities in program planning,
intervention, implementation and policy development.
7) Activate a participatory, community-based process that supports a systems approach to
realize the above goals.
As a result of our initial planning in response to your invitation, we identified several areas that
need attention to reach these goals. Communication and coordination among existing
stakeholders needs improvement and new stakeholders (i.e. representatives of the food industry)
need to be included. More efforts are needed to assure open space protection; educate elected
officials about the connections between local food and public health; increase access to healthy
food and physical activity; develop innovative policies; decrease costs of local, sustainably
produced food; decrease overweight and health disparities; and assure that regional planning
processes include a focus on food systems and agricultural policy.
Participants in developing this letter recognize that food systems activists, physical activity
proponents and community health promotion advocates have largely operated in separate arenas.
They see integrating efforts and making connections between food, activity and community

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health as mutually beneficial and the next logical step for expanding the effectiveness of their
efforts.
Our Community and the Target Area of Focus
The Seattle-King County region covers 2000 square miles with approximately 43,000 acres of
farmland (approximately 3% of the total area). Farmed acreage declined by 20% between 1997
and 2002, with a corresponding decline in number and size of farms. Positively, the number of
farms certified as organic tripled from 7% to 23% between 1995 and 2004 and the number of
local farmers’ markets and community supported agriculture programs increased. Sales at county
farmers’ markets totaled approximately $10,000,000 in 2005.

King County is home to 1.8 million residents. African Americans, Asian/Pacific Islanders and
persons of Hispanic/Latino ancestry account for 5.7%, 10.7% and 3.8% of the population,
respectively. Our county is home to increasing numbers of immigrants from Mexico, Central
America, Eastern Europe, Asia and Africa. Our ethnic diversity is also reflected in the more than
100 languages spoken by families in the Seattle School District.

Despite a generally healthy economy, economic disparities present a major challenge. Nearly a
quarter of the population lives in households with incomes below 200% of the federal poverty
level. Food insecurity affects 10% of households. Disparities in health are also a significant
concern. While half of our residents are overweight or obese, low-income people are 1.3 times
more likely to be obese than wealthier residents, African Americans are 1.6 times more likely to
be obese than whites and residents of suburban south King County are 1.6 times more likely to
be obese than residents of urban Seattle. Disparities in physical activity are even more
pronounced. Overall, 44% of residents do not meet national activity recommendations. Latinos
report having no physical activity at a rate 1.9 times higher than whites, low income people at a
rate 2.9 times higher than high income people and residents of suburban south King County at a
rate 4 times higher than residents of urban Seattle.

We will define two levels of community for the purposes of this proposal. Because food systems
by definition include rural areas for food production, we will include the Puget Sound region in
our food systems work. This area provides year round agriculture and serves approximately 28
farmers’ markets in the County. Because interventions to promote healthy eating and active
living are more effective when concentrated within smaller communities, we will select several
communities most affected by disparities. Our planning process will select the specific
communities based on health and social indicators, food access, availability of supportive
environments for physical activity and community readiness for change. Data from public health
and regional planning efforts will help inform this selection. We will likely focus on those with
high proportions of low-income residents and people of color in south Seattle and 6 adjacent
suburban cities. These communities are already beginning to address physical inactivity and poor
nutrition through the REACH and Steps to Health programs (see below).
Our History of Collaboration and Resulting Accomplishments
Seattle and King County have an extensive history of cross-sectoral collaborations, community
building and participatory planning. Several successful coalitions are active in the food and
fitness arena and are ready to participate in this Initiative. The shaded examples listed in the table
below are mature partnerships with a transparent structure defined through formal operational

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procedures, established communications systems and local (as well as national) recognition.
These coalitions have emphasized capacity development of their members and integration of
member activities. Below these are a few examples of the many partnerships formed for specific
collaborative projects. All of these partnerships have established valuable cross-sector and cross-
institution relationships and the trust and good will for moving ahead together.

Name Founded # Partners Activities & Accomplishments

REACH 2010 1999 68 • assessed current status of diabetes prevention and

control efforts among minority communities.
• implemented diabetes education and chronic disease
self-management classes, faith-based education, clinic
case coordination and community business activities.
• programs improved physical activity and nutrition
behaviors and disease management self-efficacy.
Steps to Health 2003 75 • implemented evidence-based strategies that promote
the reduction of asthma, diabetes and obesity.
• supported implementation of new wellness policies in
schools through menu changes, increased breakfast
participation, walk-to-school activities and a revised
physical education curricula.
Overweight 2004 75 • developed evidence-based 10-Point Plan that was
Prevention adopted as by the King County Board of Health.
Initiative • convenes organizations in King County to plan and
implement innovative programs and policies to
promote healthy eating, physical activity and healthier
built environments.
Acting Food 2006 15 • convenes stakeholders to holistically address food
Policy Council for systems issues.
Seattle and King • develops strategy, relationships and infrastructure for
County an officially recognized council for Seattle/King
County.
Physical Activity 2002 30 • presents annual awards to PE teachers who excel.
Coalition • provides communication, collaboration and networking
for organizations working to increase physical activity.
Injury Free 2004 3 • conducts walking school bus programs in concert with
Coalition for Kids school breakfast programs for school children.
of Seattle

Healthy Aging 1995 40 • provides education, awareness, training and advocacy

Partnership for older adult health on a variety of wellness topics.
Farm-to-School 2004 62 • included local food sourcing language in Seattle school
Connections nutrition policy.
Team

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 • developing a strategic plan for furthering farm-to-
school connections in King County and beyond.
Active Living by 2003 30 • launched Seattle’s Safe Routes to School with
Design/Healthy connected nutrition program and new start-up
Eating by Design checklist.
• established highly regarded walking audit approach.
• published TT Minor Elementary food environment map
and the online Seattle Green Map with grassroots
process.
Grants for 2003 4 • developed and evaluated food and fitness projects;
Healthy Youth leveraged additional funding to implement wellness
policies in schools.
South King 1984 46 • coordinates and maximizes emergency food services.
County & Seattle
Food Committees

Why our Community is Excited about Participating in the Food and Fitness Initiative
This Initiative is precisely what we need to take the next critical steps to fill the gaps in our work,
integrate efforts to create systems change and address disparities. While a moderate degree of
coordination is occurring across these partnerships, much more is needed to develop an
integrated, cross-sectoral approach to food and fitness by linking existing activities and filling
gaps. We are enthusiastic about expanding our strong collaborations, implementing best-practices
through projects and policies and engaging the political will for systems change. We know that
we would learn and grow through our interactions with the Kellogg Foundation and would
reciprocate by sharing our experience and knowledge.
To further integration, we would a) expand programs linking local producers with restaurants,
food retailers, restaurants and school/worksite cafeterias, b) make farmers’ markets more
accessible to a wider population, c) create local processing and distribution facilities to increase
markets for local food producers, d) acquire data on local barriers to physical activity and healthy
food followed by coordination of work within schools, worksites, community centers and
neighborhoods to address these barriers, e) expand partnerships that involve youth in gardening
activities to create integrated agriculture and garden-based after-school programs such as a
community garden-based urban 4-H and Youth Garden Works at Marra Farm, f) link schools,
medical providers and families with community-based opportunities for physical activity.
We would like to promote system-wide change including creation of a mandate for our Acting
Food Policy Council; expanding policies that increase access to local food for low-income
populations such as the farmers’ market nutrition programs; ensuring access to safe space for
play and physical activity; furthering our current use of health impact assessment efforts to
integrate health into land use decisions; and implementing school wellness policies.
Our Past and Current Work in Food Systems, Physical Activity and Community Health
Our community is currently engaged in programs and policymaking that integrate issues around
nutrition, physical activity, built environment and land use to tackle the problem of overweight

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and obesity. The King County Overweight Prevention Initiative has demonstrated the political
will to address these issues and provides a strong framework to shift from program-based
progress to systems-based change.

Highlights of our Past and Current Work in Food Systems:

Our region has long recognized the importance of a vibrant food system to the health of our
community. Our work in this arena has been characterized by citizen activism, collaborative
partnerships and a systems approach that addresses both policy and programming.

Farmland Preservation & Support for Local Agriculture: As early as 1979, King County citizens
took an interest in their local food system by establishing a farmland preservation program in
1979 – one of the first of its kind in the country. The King County Agriculture Commission was
established in 1995. The subsequent Farm & Forest Report (1996) identified incentive-based
strategies to continue farming in our county as well as the creation of two programs; Washington
FarmLink, which links retiring and prospective farmers and the Puget Sound Fresh marketing
program, both now operated by the non-profit Cascade Harvest Coalition.

Urban-Rural Connections: Additional initiatives to build local markets include Washington State
University (WSU) King County Extension’s Farm-to-School Connections Team of educators,
parents and other advocates who work to better the nutrition environment in schools and open
new markets for local farms and the recent Farmer-Chef Connections meeting, a collaborative
between Ecotrust and local organizations.
Food Policy: Long-time community efforts to establish a food policy council gained momentum
when Seattle hosted the annual Community Food Security Coalition conference and the first
national Farm-to-Cafeteria conference (2002). A series of “Growing a Regional Food Economy”
forums in 2004 connected a wide range of food system stakeholders and resulted, with leadership
from WSU King County Extension, in the establishment of the Acting Food Policy Council for
Seattle and King County in 2006. In the same year, the City of Seattle formed an
interdepartmental team and partnered with the University of Washington’s Program on the
Environment and the Henry Luce Foundation to explore strategies that address inequities in
access to local, healthy food and embedded environmental impacts of the local food system.
These strategies would leverage current programs including a health promotion initiative, an
edible food recovery project, support for emergency food providers, food-related climate
protection efforts and the successful P-Patch Program with 70 community gardens across the
city, special urban agriculture market gardens for immigrant and low-income populations, youth
gardening and nutrition education.

Highlights of our Past and Current Work in Physical Activity:

Initiatives in King County have prioritized physical activity in both transportation and recreation.
The King County Physical Activity Coalition promotes physical activity by shaping policy and
programming for youth and families with the greatest need. They spearheaded the “Live Outside
the Box” media campaign to reduce children’s screen time. Seattle, King County and Puget
Sound Regional Council include walking and cycling as key elements in planning, such as
Seattle’s newly commissioned Bike Master Plan. Jurisdictions within King County collaborate
on bike trails, bicycle lanes and signed bike routes. Bike to Work/School Day drew 15,000
participants, including 2000 youth, with government, non-profit, club, business and school

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support. The Seattle Department of Parks and Recreation has 28 community centers and 10
swimming pools, providing low-cost fitness and recreation activities, after-school and summer
programs, meal programs and safe places for all ages to be active. Seattle Public Schools adopted
progressive physical activity policies in 2005, with approximately 20 schools involved in Safe
Routes to School activities. In 2006, King County began an employee wellness program focusing
on nutrition and physical activity. Seattle has a Neighborhood Matching Fund that supports
community driven projects including refurbished playgrounds and new food gardens. Many
community-based programs in King County focus on promoting lifelong physical activity such
as walking, biking, swimming, running and weight conditioning. For example, Children’s
Hospital and Regional Medical Center, along with the YMCA of Greater Seattle, promotes
lifestyle change for overweight youth and their families through their Strong Kids/Strong Teens
program. Active Seattle, an Active Living by Design-funded project, works with five
neighborhood health clinics to increase walking and biking through promotion of walking maps,
Safe Routes to School and advocates for improving land use for more active living.

Highlights of our Past and Current Work in Community Health:

Community health approaches in King County are driven by a combination of data and
community demand. The efforts to eliminate racial, ethnic and income – related disparities and to
promote social justice are a priority for many community health programs in King County.
Several such programs are described above (i.e. the Overweight Prevention Initiative, REACH
2010 and Steps to Health). REACH and Steps to Health are broad, population-based initiatives
funded by the CDC that include planning and policy/system change efforts. REACH (Racial and
Ethnic Approaches to Community Health) is a nationally mandated effort to address health
disparities, while Steps to Health is nationally directed to prevent chronic disease (including
obesity) with a local focus on addressing health disparities. Other community health initiatives
that support active living include collaborations to prevent injuries among children and teens
through bike, car and water safety and development of neighborhood walking maps and groups.

The county has a well-established network of community health centers that coordinate with
community-level programs. For example, Sea Mar Community Health Centers, serving primarily
a Spanish speaking clientele and Harborview Medical Center serving all demographic groups,
provide safety net services for the indigent. Both are partners in REACH and Steps to Health.
Children’s Hospital Obesity Action Team is supporting several community clinics in making
system change to improve care and prevention of pediatric overweight.

Key Criteria for the Organizations in our Community to Serve as the Convener, Grantee
and/or Fiscal Agent
A convener, grantee and/or fiscal agent would: be successful at collaboration and committed to a
participatory process; have a broad reach in the community; have a proven capacity for
managing large multi-year grants with multiple partners and subcontracts; have been part of prior
national demonstration projects; be well respected and trusted by policymakers, community
members and fellow professionals; and have capacity to conduct training for other partners. We
are considering co-conveners with expertise in local food, fitness and community health. In
addition, the fiscal agent would have low overhead expenses, a track record of effective budget
management of projects of this scope and organizational capacity given its current workload.

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Our Community’s Readiness for System Change
Much of the prior discussion indicates that King County is ready to make a qualitative jump in
addressing food and fitness. Existing coalitions and programs see the need for systems building
and policy change to increase the effectiveness of the many individual programs that are already
in place. Local elected officials are concerned about obesity and ready to act. Our community has
been working together to reduce obesity through the Overweight Prevention Initiative, a 2 year
county-wide planning effort that addresses healthy eating, physical fitness and healthy built
environments. We need to extend this work to local food systems. We also have engaged cutting-
edge researchers at the University of Washington, Washington State University King County
Extension, Children’s Hospital and Regional Medical Center and other institutions in the region
to identify key questions, assist in program planning and conduct evaluations.

Another indication of our community’s readiness is illustrated by the swift response to your
invitation. Within two weeks, more than 40 people representing institutions, community based
organizations, policymakers, businesses and foundations met to discuss a response. They made it
clear that they were at the table to pursue the opportunity to influence policy, integrate activities
and take a systematic approach to creating healthy food and built environments, rather than to
obtain funds for their organizations’ individual programs.

Our Collaborative’s Approach to the Community Action Planning Process

To build the partnership, we will develop a governance structure and decision-making process
with formal by-laws; conduct leadership development; and establish credibility with elected
officials, businesses and community organizations through targeted outreach and implementation
of a communication plan. We will build relationships through celebration, joint efforts and team
building activities. The partnership will be well-positioned to conduct a participatory process to
identify policy priorities and activities to include in the action plan. In order to gain broad input
as we develop the plan, we will add partners. However, we recognize that some stakeholders
(especially youth, community residents and businesses) may prefer alternative channels for
participation rather than attending meetings or joining the partnership. Therefore, we will
conduct focus groups and key informant interviews, develop time-limited workgroups and/or
advisory committees, conduct community forums and attend meetings of established coalitions
and organizations. We will analyze local data on health behaviors, food and fitness-related health
outcomes, community assets and food access and availability to target and prioritize
interventions. Our local health department has produced innovative assessments of community
health issues and has access to a wide range of relevant data including community assets.

We will propose an integrated set of cross-sectoral activities based on both evidence-based

practice and practice-based evidence through review of peer-reviewed and gray literature,
consultation with experts (in the community, academia and the public sector) and web review.
We will conduct pilot activities during the planning period to guide selection of interventions for
the second phase and to assure that the infrastructure needed to implement phase two is in place.
Preparation of the plan will occur in multiple contexts in order to facilitate meaningful
involvement of the wide range of stakeholders. The principle locus will be monthly steering
committee meetings of the partnership, open to all interested parties. Workgroups will prepare
detailed assessments and plans for steering committee review and action. The steering committee

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will present proposals at the full partnership meetings for review and approval. Partnership
retreats will be scheduled for more in-depth discussions, facilitated by an external moderator.
We will use established methods and models such as PRECEDE-PROCEED, the social-ecologic
model, the Community Tool Box, From the Ground Up! and community based participatory
research (CBPR) methods to guide the planning process and partnership development. We will
develop communication mechanisms based on partner preferences that may include a website,
extranet, list-serve, email groups, media and a newsletter.
Our Approach to Evaluation and the Quality and Availability of Data
Evaluation of the planning phase will focus on providing formative and summative feedback on
progress of the partnership in developing the characteristics of a successful coalition and
preparing the action plan. We will use methods of CBPR and “empowerment evaluation” to
assure the collaborative nature of the evaluation.
Outcome measures to assess action plan development may include completion of specific,
measurable products such as an asset map and needs assessment; prioritized actions for phase
two; a community action plan which includes integrated partner activities; systems change
strategies and a plan for coordination with other regional planning processes. The evaluation will
assess the degree to which the plan takes into account best practices, local conditions and the
local political, economic, cultural and ecological environment.

A second set of indicators will measure the attainment of characteristics of successful coalitions,
(i.e. membership, structure, bylaws, leadership, trainings, enhanced member skills, new
collaborative efforts, completion of vision and mission statements, effectiveness, visibility) from
the perspectives of members and key stakeholders outside the partnership.
This evaluation will primarily use qualitative techniques. We will collect data from participant
observation at partnership meetings, in-depth semi-annual interviews with representative
members, reports, meeting notes, attendance lists, products and activity logs of partners.
Qualitative data may be supplemented with an annual member survey assessing satisfaction with
the partnership using tools such as CSAS.
A number of our current partners have nationally recognized research and data capabilities
including the Center for Public Health Nutrition at the University of Washington (Drewnowski et
al), the Epidemiology, Planning and Evaluation Unit of Public Health (Krieger, et al) and the
Group Health Community Foundation (Beery & Cheadle, et al). All have extensive experience
evaluating coalition-based approaches to community health promotion. Through a collaborative
effort, the evaluation team will be selected by the project steering committee.
In Summary
King County, Washington and its surrounding region is ready and eager to further our efforts to
improve our systems of healthy food accessibility; infrastructure and program support of
physical activity; and overall efforts to reduce obesity, other chronic conditions and risk factors
and health disparities. Our strengths lie in our extensive resources and expertise, tangible
political will and our broad base of knowledgeable community partners who will work together
and with policy makers to develop and implement policies and programs to further these ends.