In public health policy campaigns, sometimes the right player stepping up to the plate at the right time can give advocates the strength and momentum they need to bring the 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 American Heart Association (AHA) helped turn a pilot project to ensure healthier offerings were available in vending machines on Baltimore city government 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 up 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.
Working in partnership with the Baltimore City Health Department’s Office of Chronic Disease Prevention, the AHA was a natural to lead the effort to make the policy permanent due to the alignment with the mission of the organization and the fact that they have advocacy staff members who are long-time fixtures in public policy in Maryland.
“The organization has always been trustworthy and we have always used science to back up and support our work,” notes Michaeline Fedder, Maryland government relations director for the AHA, who led the effort.
Ashley Bell, vice president of government relations of the AHA’s Mid-Atlantic Affiliate, says that trust was also critically important to the process because of its impact on policymakers.
“The American Heart Association has high name recognition and trust with both the public and especially policymakers,” she says.
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 conducted. The Voices for Healthy Kids team provided technical assistance over the course of the 18-month process.The effort was helped by Baltimore’s long history with health and healthcare and a focus on addressing health disparities that exist throughout the city.
“People understand the message as to the importance of healthy eating, in part, because Baltimore is a community of health—it is home to the Johns Hopkins and University of Maryland medical institutions," says Fedder. “So healthy eating efforts have already been introduced—people know it’s important to eat healthy.”
The policy ensures vending machines provide items with no trans-fat and that are lower in sodium. Fifty percent of the foods offered must be low in saturated fat, low sugar, and low 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 are 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.
It’s no surprise that the success of the Baltimore healthy vending policy has already started a ripple effect throughout Maryland.
“We are working on passing a similar policy at the state level that would apply to all vending machines on state property,” says Bell.