Upstream interventions? Or stay out of the water

(Originally published in March, 2014)

I was trying to cleverly stretch the image of moving care interventions “upstream” all the way to the “headwaters of health.” Then this came across the Web:

Obesity between the ages of 5 and 14 years was more likely to have occurred at younger ages, primarily among children who had entered kindergarten overweight.[1]

So much for healthy headwaters. But then, maybe the actual stream of interventions isn’t where anyone wants to be in the first place.

So let’s paddle down a short way, scramble up the bank, and go inland. Here is a small village. Its people are kindly and welcoming, even if their rules are a tad rigid. Not far from the main building is a small plot of turf close to a collection of seesaws, a jungle gym, an HVAC unit and a softball field.

That small patch of land is, of course, the humble school garden, a totem for health-creating possibilities in schools that are still vague, unfolding, tentative, and disconnected. Such plots can now be seen on and around countless school grounds. They have been unearthed from heavy crusts of playground macadam, carved out of slivers of lawn between school and street, had grass and weeds shaken out, and been tilled and planted all across the inland territories. Often touted as inspirations for obesity-deflecting behaviors and for stimulating STEM aptitudes, the garden also carries a deeper health-creating potential, for aggregating the other activities now appearing on K-12 campuses: food prep, nutrition, cognition-improving exercise, mindfulness, and environmental awareness.

School gardens also represent far more potential for improving children’s health within the school setting than is evident in the uneven funding that they attract and in how they relate to other school-centered activities that can improve health. All the same, the school garden surely is at the center of a movement. Countless numbers are in place across the country, at various stages of development and adoption. The U.S. Department of Education’s “Green Ribbon Schools” awards program recorded 300 gardens among the 78 K–12 schools selected in the second year of the award in 2013.[2] That is a small sampling of the national total.

Gardens can be organized around several objectives: (1) to combat obesity, as an experience that can create early paths into healthy lifestyles; (2) to stimulate an interest in science; and (3) to emphasize the environment and address the “nature deficit.” A school may also include other health-strengthening activities, notably exercise and more recently dealing with stress and anxiety through mindfulness programs. How many K–12 schools embrace all of these? That is unknown, as are the actual health benefits derived from participation in any of them.

In part, this is due to the distinct origins and development of individual endeavors that have not been seen in or around schools until recent years. Each has evolved independently driven by the passion of dedicated advocates who have defined their value, established, or located supporting research and evidence and who have closely guarded their carefully nurtured financing partners and sponsors. Important strides have been made independently in these fields, even as a suitable place for them in K–12 education remains mostly in underfunded prototypes. Let’s consider two on either shore of the Chesapeake Bay.

School Nutrition Agri-Culture (SNAC), Selbyville, Delaware

The SNAC program is centered in a school garden at the Southern Delaware School for the Arts (SDSA), a public K–8 elementary school in Selbyville. SNAC is a program housed within the Delmarva Community Wellnet, a regional nonprofit organized around sustainability issues and programs, developing and managing in green projects, recycling, and energy business development. Its mission is “to engage children and business leaders in the demonstration of economic and practical solutions for sustainable living.”

SNAC is the creation of Kim Furtado, a cofounder of Wellnet and a naturopathic physician. Over several years, she has shepherded SNAC into a well-regarded place in the school. Furtado developed the program “to develop best practices in a garden-based curriculum that addresses obesity.” (Delaware ranked 16th in the country in obesity among 10- to 16-year-olds in 2011.)

(See this video showing SNAC garden activities, starting at :40),

Furtado reports: “SNAC purposefully weaves health, curriculum, and environmental awareness into a program that is enjoyable and fun for children.” Importantly, SNAC has become part of the curriculum at SDSA, rather than being conducted as an afterschool or weekend program. On Fridays in the fall and spring, classes rotate through the garden, each grade taking on an age-appropriate task that has been designed to complement the standard curriculum.

As a naturopathic doctor, Furtado has a somewhat unique view of the garden’s potential for creating health through several of the program’s aspects, in addition to nutrition and food awareness. “There is an abundance of research,” she notes, “that demonstrates garden-based lessons increase science achievement scores, social behavior skills and environmental attitudes, health, and life skills.”

The school’s educators have noticed these effects. Principal Neal Beahan has observed improvement in science test scores and problem solving. He and 26 teachers signed a statement of support for the program, stating that SNAC “transforms schoolyards into vibrant classrooms…using nature as a resource to drive creative instruction, and bring life lessons to the new curriculum.”

Although this garden has found a place on the SDSA campus and is establishing an effective model that supports core curriculum requirements, SNAC, like many if not most such programs, remains outside the institution itself, in the land where funding and resources are unpredictable. The program is financed by private donors, and Furtado’s time is provided through the Delmarva Wellnet. She hopes to obtain a grant from the U.S. Department of Agriculture’s Farm-to-School Program this year in order to create the next SNAC school and replicate the curriculum for others. (Note, 12-2016: Sustainability remains the ongoing issue for this garden program — Ed)

Mission Thrive Summer, Baltimore, Maryland

Across the Chesapeake from Selbyville in Baltimore, the “Mission Thrive Summer” program is not built around a single school’s garden but rather around a large urban farm operated by the city at Clifton Park. Designed for rising 9th- to 11th-graders, the program purposefully blends those health-creating activities familiar in the SNAC program—the farm/garden and its attention to food, nutrition, cooking, and ecology — with physical and exercise fitness and mindfulness. Uniquely, a core activity in the Mission Thrive model is health data collection and evaluation.

Mission Thrive Summer is a joint program of the Institute for Integrative Health (TIIH) in Baltimore’s Harbor East neighborhood and Baltimore’s Civic Works and its “Real Food Farm” program. TIIH, which conceived the project, is an independent health science and healing research organization whose founder, Brian Berman, MD, is also the director of the Center for Integrative Medicine at the University of Maryland Medical School. One of the missions at TIIH is to apply the evidence-based lessons developed from research on therapies such as mindfulness and nutrition to real-world settings like neighborhood schools.[3]

As a research-oriented organization with deep roots in integrative medicine and health, TIIH applies a “whole-person-health” perspective to understanding the impact of student participation in a process that might include a radical adjustment to diet, yoga, and meditation sessions that is experienced over the course of several weeks in the summer. For kids whose health might be routinely challenged by many factors, the Mission Thrive program offers an evidence-based way to begin to reduce unhealthy conditions by providing access to healthier lifestyle options, with education and support.

Here is a summary of Mission Thrive Summer in 2015.

The Health Curriculum

The real question posed by these school garden initiatives and other health-strengthening activities that are finding their way onto K–12 campuses is whether they should come inside the institution. Should a coherent curriculum of “personal health” be put in place in the age-appropriate manner that the SNAC program and many school gardens bring the grades into progressive levels of participation and awareness?

As we routinely talk about bending cost curves and promulgating wellness, prevention, and healthy lifestyles, the fitful evolution of these health creation activities may, at worst, inculcate the K–12 generations with a sensibility for their own health and allow them to develop far better control over the factors that affect it than their predecessors have been able to do.

One wonders what the outcomes might be if real support were put under the thousands of school garden programs across the country like SNAC and whether a full understanding of the potential of health-creating activities like those in place at Mission Thrive Summer was attained. There are plenty of people and experience out there who have an idea.

[ 1 ] – Cunningham, A., Kramer, M. R., & Narayan, K. M. (2014, January 30). Incidence of childhood obesity in the United States. New England Journal of Medicine, 370, 403–411. doi:10.1056/NEJMoa1309753 –

[2] U.S. Department of Education. (2013). Highlights from the 2013 honorees. Retrieved from http://www2.ed.gov/programs/green-ribbon-schools/index.html

[3] At Baltimore’s Centennial High School, a physics teacher has introduced meditation and mindfulness exercises as coping strategies for surviving the school’s highly competitive culture: Holzberg, J. (2014, January 18). Centennial High becoming ‘mindful’ of the benefits of meditation.” The Baltimore Sun. Retrieved from http://www.baltimoresun.com/news/maryland/howard/ellicott-city/bs-ho-centennial-meditation-class-20140118,0,3272785.story.

The TIME magazine February 2014 cover story, “The Mindfulness Revolution,” describes the work of Mindful Schools (www.mindfulschools.org), whose objective is to infuse mindfulness throughout education, including for teachers.