The power of peer education: Nutrition education outreach at second harvest food bank

WATSONVILLE, CA —In a Watsonville elementary school auditorium, sixty adults brainstorm ways to incorporate exercise into their busy lives. In a meeting room at nearby Church of the Nazarene, several dozen men, women and children whip up delicious licuados, or smoothies, made with fresh spinach, oranges, and melon. At Dominican Rehabilitation Hospital, thirty women take a brisk stroll around the grounds before gathering in a third-floor lounge to cook vegetable stir-fry with brown rice, garlic and ginger.

All of these activities are a part of the nutrition education and outreach services of Second Harvest Food Bank of Santa Cruz County. By combining fresh fruit and vegetable delivery with health education, Second Harvest is empowering food bank members to become active participants in their community’s nutrition education. It’s just one of many ways in which Second Harvest has transformed itself from a “food bank” to a “nutrition bank”. Along the way, they are creating the community organizers of tomorrow.

"CHEAP FOOD IS KILLING PEOPLE"

“In the last three decades, the number of children suffering from obesity and related illnesses such as diabetes, asthma and heart problems has grown dramatically,” according to Joel Campos, Senior Manager of Outreach and Education at Second Harvest. “These programs are designed to educate and mobilize the community to think about what they are eating and the effect it is having on their health.”

The area surrounding Second Harvest’s Watsonville warehouse seasonally employs 25,000 migrant farm workers. Paradoxically, issues of cost, access, advertising, and education keep many of these workers from eating the fresh fruits and vegetables they harvest.

“Anti-hunger efforts were traditionally defined as insufficient calories,” said Second Harvest CEO and Executive Director Willy Elliott-McCrea. “But malnutrition has shifted to focus on inadequate access to healthy food. Cheap food is killing people. It’s a cultural genocide. It’s not that poor people prefer to eat processed junk food, it’s all they can afford. Meanwhile, the American food industry is investing 12 to 15 billion a year promoting cheap food to communities of color. It’s really an issue of social justice.

“Given what we’re up against, the most powerful tool is peer education,” Elliott-McCrea continued. “It’s house to house and neighborhood to neighborhood. This is basic community development work.”      

CULTURALLY RELEVANT, COMMUNITY-BASED HEALTH EDUCATION

At Freedom Elementary School, a volunteer in a bright green Nutrition Ambassadors shirt is standing on the auditorium stage talking about the importance of exercise. He knows that his audience members are unlikely to belong to a gym or have unlimited free time to work out. Instead, he focuses on ways they can incorporate physical activity into things they already do. Holding onto the back of a chair, he demonstrates simple stretches to complete while watching a favorite telenovela, or Spanish-language soap opera. Women in the audience, many with toddlers on their laps, roar with laughter as the man animatedly bickers with a character on his imaginary television set.

This is the magic of peer education, according to Campos, who runs Nutrition Ambassadors, a school-based nutrition outreach program. Instead of sending outside professionals into a community to tell the inhabitants what to do, Nutrition Ambassadors gives community members the tools to run things themselves based on their knowledge of community members and their needs.

“We recruit volunteers at each school to run the program and then give them training and support materials,” Campos explained. “The parents make it their own and come up with their own name at each site. Everyone who attends is given food, but those who stay for the entire educational event receive more. It’s an incentive program, not just a give-away.”

Nutrition Ambassadors is the latest incarnation of Passion for Produce (P4P), a nutrition education program which currently operates at 14 sites throughout Santa Cruz County, serving approximately 850 families per month. It will expand to 20 sites by summer of 2012.

“We practice a peer-to-peer model, in which we train volunteers on the basic concepts of nutrition and have them teach their family, friends and neighbors,” said Teresa Moran, Nutrition Programs Manager. Interested community members, many of whom are Food Bank clients, take part in a 6-week training to become certified promoters, or promotores, for the program. Community members gather at area schools, churches, and community centers twice a month to learn from the promotores about exercise and healthy eating on a budget. At the end of each class, participants receive a bag full of seasonal fruits and vegetables.

At a recent P4P meeting at the Church of the Nazarene, strawberries, oranges, broccoli and spinach overflowed from shiny metal buckets sitting atop cheerful yellow tablecloths. A P4P volunteer demonstrated how to make fruit-and-vegetable smoothies while explaining, in both Spanish and English, the importance of the vitamins and other nutrients in the ingredients. “Everything we are using, you will receive today,” she told her audience, pouring the thick, green liquid into little cups for distribution. “There are recipe cards in the back."

A toddler took a cautious sip, juice running down her chin, then smiled up at her mother when she realized that the sweet melon masked the flavor of the spinach.

“We use existing nutrition curricula and materials from organizations including the USDA, and county health departments, and adapt them to the language and literacy levels of our clients,” Moran said. “We have collaborative relationships with local organizations who share their specialized knowledge of topics such as diabetes or oral health. We also draw on the knowledge and expertise of our volunteers to create engaging print material and recipe cards.”

IMPROVING HEALTH BY IMPROVING COMMUNITY DEVELOPMENT SKILLS

At the end of the session, participants lined up patiently to collect their fruits and vegetables in colorful cloth bags, chatting with their friends and neighbors. A participant named Maria said that since starting the program she exercises more and “feels really good.” Another said she has learned a lot from the lessons and enjoys “seeing the women happy, walking away with their food.”

So what does the data tell us about these nutrition education efforts? Are participants actually changing their eating habits or exercising more? Are such changes making a discernable difference in participants’ health? That's the subject of the next article in this series.

Elliot-McCrea argues that, nutrition aside, participants build important community development skills that will serve them throughout their lives.

“It’s a sustainable model embedded in the community that connects people on a personal level. They own it. It’s a very powerful thing.”

Second Harvest Smoothie

3 cups fresh spinach, washed
1 cup fresh berries, whole
1 orange, peeled and quartered
1 cup melon chunks
1-2 cups water

Place all ingredients in a blender in the above order. Add 1 cup water. Blend on low, then on high. Add more water as blending, as needed. Blend until smooth.  Will keep in a tightly covered jar in the fridge for up to 36 hours. Makes 5 one-cup servings.