Sometimes in public health policy campaigns, the right player stepping up to the plate at the right time can give advocates the strength and momentum they need to bring a campaign to a successful conclusion, and as a result, make significant public health improvements. For public health advocates in Maryland, that exact scenario played out recently when the AHA helped turn a pilot project to require healthy offerings in vending machines on Baltimore city property into a full-scale policy change affecting hundreds of vending machines in public facilities throughout the city.
The Baltimore healthy vending effort initially began in late 2013 when the city’s mayor announced a Healthy Vending Pilot Project with a commitment to full implementation by 2015. When the pilot project was completed, the AHA stepped in and helped put in place a permanent policy that will positively impact the city’s 18,000 employees, as well as many of the 622,000 residents of Baltimore who visit the city’s libraries, community centers, parks, pools, museums, and skate and ice rinks.
“The AHA has always been trustworthy and we have always used science to back up and support our work,” says Michaeline Fedder, Maryland government relations director for the AHA, which led the effort.
Considering that Baltimore has hundreds of vending machines in public facilities all over the city, developing and implementing the full-scale policy was no small feat. Recommendations for the nutrition standards that would apply to all vending machines on Baltimore city property had to be developed. An extensive review of existing vending contracts — some of which were in place for three- or five-year periods and couldn’t be broken — had to be conducted. An education campaign about the link between nutrition and heart disease was implemented.
The policy requires vending machines to provide items with no trans-fat and that are lower in sodium. Fifty percent of the foods offered must be lower in saturated fat, lower sugar and lower calorie. All beverages must have fewer than 250 calories total and vegetable juice must contain less than 230 mg of sodium per serving. And 50% of beverages must contain less than 40 calories per serving, except for 100% juice and unsweetened milk.
The policy also exhibits a clear understanding of the importance of marketing and placement to consumer behavior. It requires that healthy items be placed prominently and competitively priced. For example, water is required to be stocked and placed “in the position with the highest selling potential”— high-calorie beverages get the opposite treatment.
“We didn’t take anything away; we just gave people more and better options,” says Fedder.