HEALTH IMPACT ASSESSMENT

This sourcebook provides up-to-date information regarding ADB environmental safeguards, poverty and social analysis, and compliance procedures in order to support the process of health impact assessment. It is a useful reference for ADB staff, borrowers, executing agencies, consultants, and others seeking a better understanding of how to implement health impact assessments. The publication outlines the procedures, methods, and tools that health impact assessments use to systematically judge the potential effects of a policy, plan, program, or project on the health of a population. It is useful to those who are producing a health impact assessment or public health management plan.


. Improve local Indian Orchard and Springfi eld residents' access to fresh produce and consumption of vegetables
How will the greenhouse contribute to improved access to fresh produce and its consumption?
Key HIA fi ndings: • Robust anchor institution collaboration • Potential gap between short-term and intermediate health outcomes • Increased access to healthy foods for school children

Recommendations:
• Programming collaboration to address the potential gap in healthy food access • Expand sales to include more diverse food retailers • Collaborate on the creation of a hospital-based farmers market • Create a Community Supported Agriculture (CSA) Program • Create a mobile CSA

Objective 2. Increase community support for local and sustainable agricultural practices
What is Wellspring Harvest's role and position in Springfi eld's community garden and sustainable agricultural movement?

Key HIA fi ndings:
• The greenhouse is seen as a "catalyst for community engagement" • Springfi eld has robust community support for environmental justice and local agriculture • Food systems educational programs will be available for a variety of audiences • Wellspring Harvest will create a community garden adjacent to the greenhouse • Sodexo's nutrition center and processing plant is underway

Recommendations:
• Provide educational classes for residents who wish to grow their own produce • Collaborate with Gardening The Community and the Springfi eld Public School System • Explore more ways to collaborate with Sodexo

Objective 3. Increase the number of employment opportunities for low-income individuals and provide a supportive workplace
How will Wellspring Harvest increase employment opportunities? How can workplace conditions support positive health behaviors, such as healthy eating and moderate physical activity?

HIA fi ndings:
• Finite employment opportunities • Extensive workforce training, education, and skill-sharing opportunities • Strategic partnerships for dissemination of Coop Bootcamp Curriculum • Wellspring Harvest activities eff ectively position the business to serve as proof of concept for worker-owned cooperatives

Introduction
Communities are increasingly looking for alternatives to traditional economic development approaches that largely measure success in number of jobs created without attention to whether those jobs provide family-supportive wages or whether they go to individuals with barriers to employment. One alternative that has garnered renewed enthusiasm is worker cooperatives. Worker cooperatives are for-profi t businesses that achieve economic inclusion and access to living wages through direct ownership and democratic management by their workers. A majority of new cooperative worker-owners since 2010 are people of color, underscoring their value to addressing racial economic inequality (Policy Link 2017). Their impact is even greater when combined with anchor institution investing, whereby local institutions -hospitals, universities, local government -leverage their procurement practices to support local wealth creation. This development coincides with the emergence of a new paradigm within public health, which emphasizes the social determinants of health.
Hampden County ranks last among Massachusetts counties for health outcomes (RWJF 2017). Economic security is a major determinant of health, especially in the county's major city of Springfi eld. Low incomes and high unemployment rates plague Springfi eld, but the city is young and diverse. These are assets upon which the city can build a more inclusive economy. A coalition of organizations led by the region's anchor institutions began meeting in 2010 with the goal of developing strategies for implementing community-based economic development that would create good-paying, entry-level jobs, enable residents to build personal assets, and revitalize Springfi eld's blighted neighborhoods. The Wellspring Collaborative Corporation (WCC) emerged from these eff orts.
WCC is a non-profi t that aims to create stable employment opportunities for Springfi eld's marginalized communities and build a network of mutually supportive cooperative and workerowned businesses. WCC currently creates entrylevel jobs and builds wealth for inner-city residents through an upholstery and a window repair cooperative. WCC's newest venture, Wellspring Harvest, is a hydroponic, greenhouse business that aims to increase access to local, fresh produce on a year-round basis.

Harvesting Health: A Health Impact Assessment
The successful deployment of this new workercooperative has the potential to improve economic security and the health status of Springfi eld residents. In the interest of realizing these outcomes, the Wellspring Collaborative Corporation partnered with a team of students at Harvard University to conduct a Health Impact Assessment of Wellspring Harvest. This document describes an assessment of Wellspring Harvest's capacity to ensure better health outcomes and off ers recommendations to mitigate challenges to the realization of this mission. The goal of this Health Impact Assessment is to assess Wellspring Harvest's impact on:

Individual-Level Health Outcomes
Changing the nutrition of local residents

Environment-Level Changes
Creation of jobs and environmental sustainability

Community Development Bringing diff erent sectors together
What is a Health Impact Assessment?
The National Research Council Committee on Health Impact Assessment (HIA) defi nes HIA as a, "systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential eff ects of a proposed policy, plan, program, or project on the health of a population and the distribution of the eff ects within the population. HIA provides recommendations on monitoring and managing those eff ects (National Research Council 2011)". HIA brings together local and expert knowledge into one streamlined process that draws upon the connections between health and the built environment. The process can include participation from diverse stakeholders, such as departments of planning and transportation, local, state, or tribal health departments, community members, universities, and hospitals (National Research Council Committee 2011;Quigley 2006). HIA goes beyond collecting and analyzing data on health disparities and health impacts. It can serve as a strategy to engage and co-create with community members. HIA can empower communities and facilitate multi-sectoral relationships and collaborations. Equity is at the core HIA as practitioners aim to carefully consider and weigh all stakeholder input equally (Malekafzali 2011).

Why Health Matters
The Preamble to the Constitution of the World Health Organization (WHO) (1948) defi nes health as "state of complete physical, mental, and social well-being, and not merely the absence of disease or infi rmity." It is well-documented that "good" health is a prerequisite to work, play, and thrive individually and collectively as a society. However, there is not equal opportunity for all Americans to have "good" health. Ultimately, health outcomes are deeply entrenched in education, occupation, and income and account for 80% of premature mortality (Schroeder 2016).
The Social Ecological Model (Figure 1), proposed by Bronfenbrenner in 1986, outlines how multiple levels of infl uence aff ect one's health, including intrapersonal factors, interpersonal processes, institutional factors, community factors, and public policy (Stokols 1996).
There is a robust body of literature illuminating social determinants of health, the conditions and environments in which "people are born, live, learn, work, play, worship, and age that aff ect a wide range of health, functioning, and quality-of-life outcomes and risks." Social determinants include: access to educational, economic, and vocational training, job opportunities, transportation, healthcare services, emerging healthcare technologies, availability of community-based resources, basic resources to meet daily living needs, language services, and social support, exposure to crime, social disorder, community and concentrated poverty, and residential segregation (McGinnis et al. 2002;Cole and Fielding 2007).

Reader's Guide
This report is written for Wellspring Harvest, anchor institutions (e.g., hospitals, public schools), community-based organizations, and policy advocates in Springfi eld and in Hampden County. The document serves as a roadmap to demonstrate clear connections between sustainable economic development and health and equity outcomes. In this document you will fi nd the following components:

Methods:
Describes the process and resources used to develop the health impact assessment.

Background:
Contextualizes the fi ndings and recommendations of the health impact assessment in a brief description of Springfi eld's history, demographics, and health conditions. This sections also includes a discussion of the worker cooperative model, anchor institution investment, and the Wellspring Cooperative Corporation.

Health Impact Assessment & Findings:
Includes analysis of the existing conditions and leverages health and planning literature to explore the connections between Wellspring Harvest activities and health. HIA topics are organized according to project themes and objectives.

Conclusion & Summary of Recommendations:
Summarizes key takeways from the assessment and lists actions that the HIA team considers valuable for the implementation of Wellspring Harvest's health objectives.

Methods
HIA consist of the following steps:

Screening
Determines whether a proposal is likely to have health eff ects and what type of information is needed.

Scoping
Establishes the objectives, target population, data sources, methodologies, and team members.

Assessment
Consists of a two-step process to fi rst describe the baseline health status of the aff ected population and then to assess potential impacts.

Recommendations
Based on steps 1-3, provides design alternatives and identify barriers and facilitators infl uencing the variable of interest.

Reporting
Documents and presents the fi ndings and recommendations (National Research Council Committee 2011) The team embarked on a rapid HIA process (Forsyth et al 2010). It includes steps 1-5 with key informant interviews rather than a participatory workshop. While a workshop was not conducted for the purposes of this report, WCC could consider a workshop following this process. Participants were identifi ed by the WCC leadership as key stakeholders willing to contribute expertise and critical local knowledge. We spoke to the following individuals:    Chronic conditions (e.g., obesity, diabetes, heart disease): Approximately 30% of adults are obese while 60% of Springfi eld's K-12 students are overweight or obese. Excess weight, especially in childhood and adolescence, is a major risk factor for a myriad of medical, social, and psychological conditions with serious short-and long-term implications (Ogden 2011). Springfi eld has high rates of heart disease and diabetes and higher mortality rates resulting from these conditions. Heart disease is the leading cause of death and diabetes mortality rate is 52.3 per 100,000 compared to 35.3/100,000 in

Higher Unemployment Rate
Source for all statistics: US Census Bureau 2015 racial/ethnic inequities in access to goods, services, and opportunities such as quality education, housing, employment opportunities, medical care and facilities, and a healthy physical environment, plagues people of color in their community (APA 2014). Institutional racism is closely correlated with racial residential segregation, which has already been described as severe in Springfi eld. Racial residential segregation is a key determinant of access to education and employment opportunities (Williams and Collins 2001). Both institutional racism and segregation are fundamental contributers to racial/ethnic disparities in health.  (3) that partners with lowincome Latina immigrants to build collectively owned, local cleaning businesses. Prospera addresses the inequality and lack of economic mobility for low-wage workers, especially Latinas. In addition to stable employment, cooperatives provides multiple avenues to enhance their members' talents, leadership, and creativity to advance social justice, women's empowerment, and community transformation (Prospera 2017).
The healthcare industry growing. The American Hospital Association reported that annually hospitals spend nearly $340 billion on goods and services alone. Rather than contracting out to major corporations for their goods and services, local institutions can employ and invest in local businesses (Norris and Howard 2015). Ohio Solar is expected to employ more than 100 people in the next 3-4 years. Most recently, they created a fi ve acre-hydroponic greenhouse, Green City Growers Cooperative, that sells lettuce and herbs to large institutions (Evergreen 2017).
Evergreen's alternative business model is reallocating funds to the local community. It is "restor[ing] local economic vitality, providing jobs for hard-to-employ people, and rebuilding urban fabrics and rural value chains," (Norris and Howard 2015).

"As a trusted partner in total health, we need to collaborate with local business and community leaders, and even our competitors, to create communities that are among the healthiest in the nation. This is critical to fulfi ll our mission and to make healthcare more aff ordable for all." -Bernanrd Tyson, CEO of Kaiser Permanente
Kaiser Permanente is the nation's largest non-profi t integrated health system. It advances a concept of "total health," which encompasses the physical, mental, and social well-being of its members and the communities it serves. The institution embarked on an environmental stewardship campaign with the goal of procuring all of the food it serves in its facilities locally or from farms and producers that use sustainable practices, including the responsible use of antibiotics, by 2025. Kaiser Permanente is also deeply committed to serving the local community and prioritizes supplier diversity. It purchased more than $1.5 billion from women and minority-owned fi rms in 2014 alone.
The institution is also a leader in the farmers market movement. It hosts more than 50 farmers markets at its facilities and in its communities that help staff and local residents eat well and make good choices by increasing access to fresh produce. Kaiser Permanente's food procurement practices have tremendous social, economic, and environmental impact. By investing in the community, they are addressing the non-clinical determinants of health, such as food access and economic stability and vitality (Heiman and Artiga 2015; Norris and Howard 2015).
Other cities and institutions are following suit. In Detroit, MI, the Henry Ford Health System, in partnership with Detroit Medical Center and Wayne State University, are working to localize procurement. Their primary objective is to revitalize a de-industrialized city by investing in the local community. Although the relationship is still in its infancy, it was reported that the health care organizations already redirected more than $18 million to support local businesses (Norris and Howard 2015).
In La Crosse, WI, Gundersen Lutheran Health System co-founded the multi-stakeholder owned Fifth Season Coop. It is a full-service, local food broker serving Madison, Milwaukee, Chicago, and Minneapolis. Fifth Season's sustainable, local product line includes more than 130 products and a full line of quality fresh, frozen and specialty items (Fifth Season Coop 2017). Currently, it includes 33 independent farms, three producer groups, and seven processors, (Norris and Howard 2015). Gleaning from Kaiser Permanente, there are tremendous opportunities to improve population health by supporting a community's economic vitality and access to healthy foods.

Wellspring Collaborative Corporation and Wellspring Harvest
Wellspring Collaborative Corporation (WCC) is a non-profi t that aims to create stable employment opportunities for Springfi eld's marginalized communities and build a network of mutually supportive cooperative and worker-owned businesses.
• WCC's upholstery and window repair cooperatives have proved successful in levearging local institution procurement to employ Springfi eld residents. • Wellspring Upholstery Cooperative delivers high-quality and aff ordable re-upholstery services while the Old Window Workshop is a women-owned window restoration cooperative off ering a less expensive and more environmentally friendly alternative to window replacement. Wellspring Harvest addresses job creation needs while providing fresh, local year-round produce for the community. It is expected to increase access to produce for Indian Orchard and Springfi eld residents, create new jobs, spur future workerowned cooperatives, and bridge anchor institutions and other stakeholders together. It is a catalyst to community capacity and wealth building.

Assessment & Findings
Wellspring Harvest is expected to impact community conditions and improve health outcomes over time.
Leveraging our aforementioned scoping research and our key informant interviews, we created logic models to conceptualize and track potential health impacts over time (see attachment). A logic model is a road map that presents the "shared relationships among the resources, activities, outputs, outcomes, and impact for your program. It depicts the relationship between your program's activities and its intended eff ects." Logic models help answer the where, how, what questions: Where are you going? How will you get there? What will show that you've arrived (CDC 2017)? In assessing the impact, the HIA team developed the following priorities: healthy food access, healthy economy, and equitable community development.
We identifi ed two community objectives and probing question(s) for each impact priority.

Improve local Indian Orchard and Springfi eld residents' access to fresh produce and consumption of vegetables
How will the greenhouse contribute to improved access to fresh produce and its consumption?

Objective 2. Increase community support for local and sustainable agricultural practices
What is Wellspring Harvest's role and position in Springfi eld's community garden and sustainable agricultural movement?

Objective 3. Increase the number of employment opportunities for low-income individuals and provide a supportive workplace
How will Wellspring Harvest increase employment opportunities? How can workplace conditions support positive health behaviors, such as healthy eating and moderate physical activity?

Objective 4. Provide supportive workplace to improve self-and collective effi cacy in the workplace and promote civic engagement
How can Wellspring Harvest improve self-and collective effi cacy in the workplace and promote civic engagement?

Objective 5. Improve neighborhood environmental conditions and sense of pride by catalyzing brownfi eld redevelopment
Will Wellspring's resuse of the Chapman Valve site result in reduced exposure to health harms and catalyze future brownfi eld clean-up and reuse?

Objective 6. Leverage economic development and onsite community programming to enhance social capital and civic engagement
How can Wellspring Harvest promote neighborhood level social capital and empower co-op worker-owners and residents to engage in local community development decision-making?

Existing Conditions
Nearly 15% of Springfi eld residents experience food insecurity (i.e. lack of access and/or quantity of nutritious food for household members) and nearly 16,000 residents live in food deserts, which are areas that lack access to nutritious and aff ordable food (Urban Agriculture Committee 2014; Luan 2015). Food desert neighborhoods include Bay, Pine Point, Metro Center, and Upper Hill (Figure 7). Without grocery stores, many residents rely on corner stores and convenience stores, which mostly include energy dense food products and a limited selection of fruits and vegetables. The Springfi eld Food Policy Council reports that in the Mason Square community, households experience moderate to severe food insecurity and fall into the "meal gap," where they miss meals due to economic constraints and need to turn to charitable food assistance.
Additionally, several of the key informants attested to high rate of school children eligible for free or reduced lunch and the poor quality of food in local schools. Schools lack on-site processing capacity and most of the school currently served in the schools is processed in Rhode Island. One informant shared the telling "sweet potato" anecdote. One group of elementary school students grew sweet potatoes in their school's garden. Since the processing plant is in Rhode Island, the locally grown sweet potatoes traveled over 85 miles to Sodexo's processing facility. The students had to wait several days to enjoy the fruit of their labor, and and in the process, much time, money, and energy was expended.This ancedote is a snapshot of the frustration of food access issues in Springfi eld and especially in Springfi eld Public Schools. There is a lot of interest among various Springfi eld institutions to dramatically improve the quality of food prepared.

Connections to Health
A large body of evidence supports that inequitable food access contributes to "chronic health conditions [such as obesity] and is related to higher mortality rates and years of potential life lost (Gallagher, 2007)." Black, Moon, and Baird (2014) conducted a literature review to analyze the body of evidence on the role of the food environment on dietary diff erences in developed countries among adults aged 18-60 years of age. Overall, they found strong evidence for inequities in food access in the U.S. Neighborhood median income is closely correlated with food access. More affl uent neighborhoods typically have more grocery stores and food outlets (Black et al 2014). However, trends are not as strong for other high-

Robust anchor institution collaboration:
Wellspring Harvest's business plan highlights long-term and sustainable contracts, which are expected to increase food access in Springfi eld and Indian Orchard's food deserts.

Potential gap between short-term and intermediate health outcomes:
Providing food access does not directly translate into health behaviors. There is an implicit assumption of, "if we build it, they will come" mentality.

Increased access to healthy foods for school children:
Key informants highlight pre-existing healthy food options at hospitals. However, the procurement of local produce is expected to result in a net benefi t for Springfi eld Public Schools, which lack an alternative local option.

Recommendations
To ensure equitable food access and consumption, the HIA team recommmends:

Programming collaboration to address the potential gap in healthy food access: Wellspring
Harvest could collaborate with Baystate or Mercy Medical Centers' nutrition staff and community health workers to conduct food preparation and cooking demonstrations and share recipes.

Expand sales to include more diverse food retailers:
Wellspring Harvest can contract to other grocery stores serving Springfi eld, such as Stop & Shop, C-Town, or ShopRite to ensure its produce is available to more neighborhoods.

Create a Mobile CSA:
A key informant recommended a mobile CSA truck as a best practice. Collaborate with Go Fresh, a mobile farmers market that visits food deserts throughout Springfi eld. income countries. Their analysis also highlighted the role of racial segregation and food access. Specifi cally, retailers are less likely to move into black neighborhoods. This fi nding is directly applicable to Springfi eld, since it is one of the most racially and ethnically segregated cities (Szegda 2014).

Potential Health Impacts
Since Wellspring Harvest is contracting with two medical centers and Springfi eld's public schools (i.e. Sodexo) and select grocery stores and food cooperatives, such as Big Y Supermarkets, River Valley Market, Green Fields Market, and Squash Trucking, the produce will reach Springfi eld residents. Equitable and sustained access to healthy foods is the fi rst step in improving individuals' dietary patterns. However, it is important to note that access to produce bridges one gap while additional support is needed to inform, engage, and empower individuals to consume the produce and/or prepare healthy meals.

Existing Conditions
Over the last decade, there has been growing interest and support for local and sustainable agricultural practices in Springfi eld. There are over ten community gardens. Most prominently, Gardening The Community (GTC), is a food justice organization that engages youth to grow their own produce. GTC uses urban agriculture to promote sustainable living and build healthy and equitable communities. Located in Mason Square, GTC uses vacant and abandoned lots to grow produce for their participants' use. They also sell their crops to Mason Square Farmers Market, local restaurants, and bodegas/corner stores (Gardening The Community 2017). GTC was highlighted as a premier organization by all of our key informants. In addition to GTC, the Putnam Vocational School also off ers an educational greenhouse program. Students can concentrate in arboriculture, greenhouse management, fl oriculture, landscaping and turf management, and natural resources -park management.

Connections to Health
Local agriculture is noted to improve a variety of health variables. The Sustainable Agriculture Research and Education Program and the Agricultural Sustainability Institute at UC Davis conducted a literature review and found that local agricultural practices improve food access and security, increase fruit and vegetable consumption, improve food and health literacy as well as general well-being which includes mental health and physical activity (Labrador 2016).

Potential Health Impacts
Community partnerships and outreach events play a large role in improving awareness of local agriculture practices which then shapes food access as well as norms about healthy foods.
A large study in Flint, Michigan, a post-industrial and majority low-income city found that when individuals or their family members partake in a community garden they are three and a half times more likely to consume more fruits and vegetables than individuals without a community gardener in their network (Alaimo et al. 2008).

Key Impact Assessment Findings
The greenhouse is seen as a "catalyst for community engagement": The stakeholders want to leverage the greenhouse as an incubator for learning and community engagement. A key informant noted that if successful, the greenhouse will be "contagious."

Springfi eld
has robust community support for environmental justice and local agriculture: Multiple key informants highlighted GTC as a leading organization.

Food systems educational programs will be available for a variety of audiences:
The program will include tours of the greenhouse to teach residents and students about hydroponic growing and to test new crops for production.

Wellspring Harvest will create a community garden adjacent to the greenhouse:
Community garden beds and community section of the greenhouse are underway but need to be executed promptly to address community needs and requests.

Sodexo's nutrition center and processing plant is underway:
(Springfi eld Public Schools 2017), it is seen as an much needed infrastructure to foster agricultural education, employment opportunities, and culinary training.

Recommendations
Leveraging Springfi eld's strengths and already strong support for community gardens, it is recommended that Wellspring Harvest:

Provide educational classes for residents who wish to grow their own produce:
A key informant highlighted how food can be grown "everywhere" but residents need the knowledge and resources to do so. If possible, couple gardening demonstrations with a mini-garden starter kit. Engage local community centers to provide adult gardening classes and pilot new produce that are both culturally specifi c and seasonal. Explore a collaboration with Springfi eld Housing Authority to ensure opportunities reach residents of the nearby public housing developments.

Collaborate with Gardening The Community and the Springfi eld Public School System:
to build and sustain community gardens tailored to children and youth and to share food systems educational resources and opportunities.

Explore more ways to collaborate with Sodexo:
Sodexo is building a 62,000 square foot culinary and nutrition center at 75 Cadwell Drive, only 2.5 miles from Wellspring Harvest, 121 Pinevale St. Sodexo is a leading food services and facilities management company. Forging a working relationship could be both fi nancial viable and advance community programming goals.

Existing Conditions
Many Springfi eld residents face signifi cant barriers to being hired into and/or remaining employed in area jobs, especially individuals with low educational attainment or a criminal record (Hampden County Health Improvement Plan 2017). Springfi eld's labor force participation rate (59%) is lower than that of the state, and unemployment rates range from 7.8-15.3% for diff erent neighborhoods. Unemployment also varies greatly by race. The unemployment rate hovers around 13.3% overall, but non-Hispanic whites have a rate of 7.9% compared to 17% for Hispanics/ Latinos (US Census Bureau 2015). Springfi eld's employment landscape has deteriorated in the last few decades. Manufacturing, once the core of the city's industrial sector, only employs 9.8% of Springfi eld workers. It employed 34 percent of Springfi eld workers in 1960. Many employers closed shop, but a signifi cant proportion moved to Springfi eld's outskirts, where they continue to provide employment for semi-skilled workers in the Springfi eld metro area. Almost half of Springfi eld workers are employed outside of the city (US Census Bureau 2015). The distance between Springfi eld's residential neighborhoods and these jobs is especially a barrier for Springfi eld's poorest workers, which are concentrated near downtown (Federal Reserve 2010).

Connections to Health
Unemployment and lack of occupational opportunities infl uence health on several levels.
The seminal Whitehall Study in the UK found that job insecurity has been linked to several adverse health outcomes, such as mental health, psychosomatic symptoms, loss of self-esteem, anxiety, and minor psychiatric symptoms, lower levels of self-reported health, and increased incidence rates of hypertension, coronary heart disease, and myocardial death (Marmot and Allen 2014;Schroeder 2016). In contrast, better wages make it easier for individuals and families to access quality housing in a healthy neighborhood, childcare, more nutritious foods, and healthcare services. Good jobs provide safe working conditions and opportunities for upward mobility (RWJF 2013). Workforce training and elimination of barriers to for individuals of diff erent abilities are key to promoting access to good employment.

Potential Health Impacts
Wellspring Harvest proposes to grow from fi ve to nine employees within three years of operation. Employees will receive signifi cant on-site training, and some training opportunities will also be available

Key Impact Assessment Findings
Finite employment opportunities: Since Wellspring Harvest expects to employ 5-9 employees in the next three years, the co-op is unlikely to address community-level income inequities in the near to mid-term.

Extensive workforce training, education, and skill-sharing opportunities:
Task rotation maximizes on-the-job learning. Similar skill building opportunities will be extended to local students. These skills can empower students and workers to move into jobs with higher skill requirements and pay, or alternatively, transfer this knowledge to the development of a business.

Strategic partnerships for dissemination of Co-op Bootcamp Curriculum :
WCC off ers a wealth of aff ordable opportunities for training in the development of a worker-owned cooperative and has established partnerships with key entities, such as the Springfi eld Technical Community College.

Wellspring Harvest activities eff ectively position the business to serve as proof of concept for worker-owned cooperatives:
Its fi nancial viability and community-oriented business model are intended to inspire other cooperatives. A key informant highlighted two additional worker co-op opportunities: housecleaning and lawn care. Another informant noted that Wellspring's Harvest eventual success will be measured "not in the number of employees, but number of worker cooperatives in the community." to students at Putnam Vocational High School and Springfi eld Technical Community College. Long term, Wellspring Harvest is anticipating incubation of other food related businesses employing 50 people within fi ve years (Rose and Kawano 2017).
Harvest is expected to employ 5 to 9 employees in the fi rst three years, there is a limited reach of improving income inequities on a large scale. If feasible, provide opportunities to develop capacity around worker co-ops more frequently and in diverse settings (e.g. churches and community events) to attract and reach more individuals and to bring diff erent sectors together.

Integrate elements of a career pathways program into partnership with Putnam Vocational School and Springfi eld Technical
Community College: Capitalize on educational and internship collaboration with these institutions to ensure that participating students are well positioned for WCC or alternative workercooperative business growth or incubation job opportuntunities. Incentivize their participation in Co-op Bootcamp or similar training.

WCC can provide additional vocational job training: Collaborate with medical centers' Human
Resources department to provide additional vocational job training, such as food processing, catering, and retail sales.

Existing Conditions
A supportive workplace can drastically infl uence one's health and well-being. Research identifi ed the importance of being able to set the pace of work, task variation, autonomy, learning new skills and the opportunity to apply them, and sense of meaning and connection in the workplace (Griep et al. 2015). Finding research literature about selfand collective-effi cacy among members of workerowned cooperatives was a challenge for the HIA team. A study of uninonized food cooperative employees in Vermont, found that a union, rather than the cooperative structure, was a primary vehicle for employees to infl uence workplace decisions and encourages civic engagement outside the workplace (Reuge and Mares 2016).

Greater sense of confi dence and pride:
Digital story telling project focused on other WCC businesses has captured some evidence of improved worker self-confi dence. Continuity of leadership and institutional culture likely to produce similar impact at Wellspring Harvest.
Ability to eff ect greater civic engagement is uncertain: There is a paucity of research that evaluates the eff ects, both short-and longterm, of workplace democratic organizations and worker-owned cooperatives on collective effi cacy and civic engagement. (Hatcher 2007)

Plethora of workplace training and collective decision-making opportunities:
Enhances sense of pride and belonging while developing skills transferable to civic spaces

Conduct longitudinal evaluations:
WCC's connections to UMass and other local educational institutions are an opportunity to fi ll the gap in research linking worker-ownership to better health and civic engagement. Track employees health outcomes, confi dence, and civic engagement over time.

Provide a workplace that aligns with WHO healthy workplace model:
The World Health Organization (WHO) proposed a healthy workplace model, where "workers and managers collaborate to use a continual improvement process to protect and promote the health, safety and well-being," (WHO 2010). Their model includes health and safety concerns regarding the physical work environment. This includes work organization, workplace culture, providing support and encouragement of healthy lifestyles, and various pathways to participate in the community to improve the health of workers, their families, and members of the community (WHO 2010).

Encourage and incentivize workers to participate in the Indian Orchard Neighborhood
Council or other community activities.

Connections to Health
Leading health theorist, Albert Bandura proposed that self-effi cacy and collective-effi cacy, more simply understood as confi dence, are key factors for achieving all types of behavior change, from health behaviors to civic engagement. Selfeffi cacy is a person's confi dence in his/her ability to perform behavior that leads to outcome while collective effi cacy is belief in the ability of group of individuals to perform a concerted action to achieve an outcome (Bandura 2001). Perceived confi dence to fulfi ll occupational demands aff ects both the psychosocial (e.g. stress) and physical health of employees. Individuals who perceive low confi dnece exhibit physical and emotional exhaustion, lack of any sense of personal accomplishment, and occupational disengagement through cynicism about one's work (Bandura 2000). Low occupational confi dence can lead to job-strain. First discussed in Karasek's Job Demand-Control Model, job strain is the physical and psychological hardships embedded in inadequate power to respond to occupational demands and expectations. Job strain is shown to increase heart disease, poor job satisfaction, and "burn-out" (Egger and Dixon 2014).

Potential Health Impacts
The worker-owned cooperative model strives to encompass both supportive activities that foster productivity as well as confi dence. These activities are building blocks to promote civic engagement outside of the workplace (Reuge and Mares 2016). For example, worker owners engage in on the job democratic decision making that provides insights into their capacity for mutual governance and operational agreements. Exposure to and intimate knowledge of these processes are expected enhance employees' agency to advance equitable practices and community transformation (Reuge and Mares 2016). Melissa Hoover, Executive Director of the U.S. Federation of Worker Cooperatives highlights that the cooperative model is inextricably linked to addressing social justice. Specifi cally, "co-ops are a way to build equity in society -not just fi nancial equity but societal equity for people who have traditionally been left out," (Casper-Futterman 2011).

Equitable Community Development
Objective

Existing Conditions
This section specifi cally focuses on the potential impacts of neighborhood development neighborhood development associated with the siting of Wellspring Harvest in the Indian Orchard neighborhood (Figure 9). Indian Orchard is located on the northeast corner of Springfi eld. The ability to generate power from the Chicopee River attracted many large textile operations starting in the mid-1800s and spurred Indian Orchard's early growth. Housing and commercial development soon followed to meet the need of the factories' workers. As a result, Indian Orchard developed separately from Springfi eld and features a diverse mix of uses and residential densities (Springfi eld 2015). The neighborhood has its own identify and main street.
Wellspring Harvest is located on 1.5 acres of the old Chapman Valve site. There have been several eff orts to redevelop the site within the past 20 years (masslive.com 2015). The Indian Orchard Neighborhood Council has indicated a preference for development with jobs and is engaging local businesses to generate ideas for future uses of the neighborhood's vacant sites.
Chapman Valve employed nearly 3,500 people at its peak. The manufacturer left a legacy of contamination, which includes uranium, oils, asbestos, and polychlorinated biphenyl (PCBs). The city has made extraordinary eff orts to remediate the 54 acre site and fi nd new users.
In 2015, the city released an request for bids on a portion of the site with no success. That same year, WCC approached the city with a proposal to locate Wellspring's new greenhouse venture on the site (masslive.com 2015 and 2016).

Connections to Health
The elements of a healthy neighborhood include protection from harmful exposures including pollution and crime, improved walkability and transit to community resources, and diverse housing opportunities. Older neighborhoods with a legacy of industrial activity often face barriers to redevelopment stemming from a prevalence of brownfi eld sites, which can expose nearby residents to harmful substances. Indirectly, vacant and blighted lots may provide opportunities for crime and can discourage local economic activity (Berman and Forrester 2013).
Good planning can catalyze remediation of brownfi eld sites and prevent future exposures through careful siting of new industrial and commercial land uses. Redevelopment can also enhance access to community resources, including jobs and recreational spaces, through the creation of new sites and improved mobility and public realm infrastructure.

Potential Health Impacts
WCC purchased 1.6 acres from the Springfi eld Redevelopment Authority. After several months of remediation activities, construction of the fi rst phase of the greenhouse facilities is currently underway. Most production will occur on a 40-hour workday, bringing regular activity to a site that has sat vacant for many years. The Wellspring Harvest property and an adjacent 16-acre portion of Chapman Valve site form part of the Indian Orchard Business Park.
Reduced blight and risk of exposure to harmful substances: 1.6 acre site has been redesignated as 'No Siginfi cant Risk' to human health. Active use also discourages vandalism through increased 'eyes on the street.' Potential exposure risk related to cleanup standards: Literature emphasized distinction of cleanup standards adequate for employment versus recreational reuse. Also, unremediated adjacent site still poses a risk. Care will be needed to ensure general public is not adversely exposed.

Ability to catalyze adjacent brownfi eld redevelopment & siting of incubated businesses
within Indian Orchard uncertain: Additional sites are larger and under diff erent ownership. Their remediation and redevelopment may be more challenging.

Mitigate Brownfi eld Contamination Exposure:
Ensure community garden participants are properly trained and protected from exposure to contamination stemming from adjacent sites or potential resurfacing soil contamination.

Engage and Support Capacity of Indian Orchard Neighborhood Council:
The Council's economic development subcommittee is actively engaging with local businesses to ascertain what kind of future economic activity they'd like to see in the neighborhood, specifi cally in relation to the neighborhood's vacant parcels. Participate in and develop the subcommittee's capacity around worker cooperatives.

Existing Conditions
A neighborhood of 8,518 people, Indian Orchard is majority persons of color. It trends slightly worse for median household income ($32,759), unemployment (14.7%), and poverty (33.4%). Indian Orchard is unique in its prevalence of young people. The population of people under 18 is 31.6%, which contributes to a lower median age (29.9) in Indian Orchard compared to Springfi eld (32.4). The neighborhood's younger population suggests a need for ensuring that on site programming and opportunities are available to youth. The neighborhood also has a signifi cantly larger renter population compared to the city overall (64.8% vs. 52.2%) (US Census Bureau 2015). The higher prevalence of renters may be due to the large public housing developments in the neighborhood, but it also indicates a need to simultaneously pursue preservation and development of aff ordable housing with any redevelopment activity in the neighborhood.
The Indian Orchard Neighborhood Council formally engages in local planning activities on behalf of the neighborhood. According to the Council's president, the group is most active on issues of economic development. It hopes to encourage new business activity in the neighborhood while maintaining the community's character and would like to see greater participation in Council activities as a result of Wellspring Harvest's development.

Connections to Health
Redevelopment that results in new opportunities for urban agriculture increases property values and reduces the need for public spending on illegal dumping and vandalism. Community gardens also create opportunities for planning and shared decision-making, which foster democratic values and civic engagement (Golden 2013). Evidence shows that this kind of neighborhood change contributes to a greater sense of neighborhood quality, which is associated with elevated social capital and sense of belonging (HAPI 2015).

Potential Health Impacts
Wellspring's plans demonstrate and interest to engage in the community as much more than an employer. WCC has secured funding to realize educational programming for students and residents. A portion of the site will be dedicated for the development of a community garden and the Indian Orchard Neighborhood Council President sits on the transitional board of Wellspring Harvest.

Community
Garden & Educational Programs Match Community Interests with Wellspring's strengths: WCC has proposed and is organizing neighborhood wide workshops and a community garden. Literature supports fi ndings of increased social capital and civic engagement resulting from these investments, but staff and site capacity is limited.

Improved Perceptions of Neighborhood
Quality: Construction activities have already generated expressions of pride and optimism. Wellspring Harvest worker-owner shared anecdote of local neighbor keeping watch in evenings to ensure security of construction equipment, demonstrating some initial evidence of increased social capital.

Ensure
Adequate Staffi ng Community Programming: Community garden will require staff support at least initially. The half-time position identifi ed in the business plan for this activity may be insuffi cient to maximize engagement.

Encourage and Participate in Neighborhood
Planning: Participatory planning can facilitate community visioning around equitable future brownfi eld redevelopment and worker-coop incubation.

Figure 10 builds upon Stokols Social Ecological
Model to map the expected universe of benefi tted stakeholders and environments. These groups range from individuals directly engaging with Wellspring Harvest and its products to the surrounding community, institutions, and policy environment.

Individual-Level Health Outcomes
Wellspring Harvest is expected impact individuals through the creation of job and food systems workforce training opportunities. Wellspring also expects to improve access to fresh produce for Springfi eld metro area consumers, specifi cally students in local public schools and individiuals residing in food deserts. Employment and access to healthy foods are both key drivers to improve health outcomes.

Community Development
At the broader community-level, Wellspring Harvest will contribute to stronger multi-sectoral partnerships and Indian Orchard neighborhood revitalization eff orts. Wellspring's environmentally sensitive operations also provide a model for local agricultural production that reduces food miles and water consumption.

Environment-Level Changes
Wellspring Harvest will also help anchor institutions maximize their community impact. Investments in and partnerships with WCC complement a transition in health care services that highlights "volume to value" approaches. Wellspring's success can help local hospitals fulfi ll their ACA mandates and qualify for certain tax benefi ts. Through its programming, Wellspring Harvest is expected to act as a catalyst for improved nutrition and food systems education in public schools, colleges, and universities.
Lastly, Wellspring Harvest has major policy implications. It is a new business model that addresses community needs and social determinants of health. Over time, it is expected to exhibit regional food self-suffi ciency and inspire other worker-owned cooperatives. As one informant underscores Wellspring Harvest's success is expected to be "contagious" throughout Springfi eld and in the Pioneer Valley.

Achieving the Outcomes
Wellspring Harvest's success as a business and ability to realize the health impacts and recommendations outlined in this assessment hinge on the cooperation of diverse sectors and stakeholders.
Bryson and colleagues (2006) underscore how multisectoral collaborations often tackle society's most diffi cult public challenges. Yet, such collaborations are complex and sometimes circuitous. Many factors, including varying responsibilities, policies, values, leadership, institutional capacities, levels of trust, levels of confl ict, funding, and negotiating risk, often complicate and/or hinder the use and viability of these collaborative endeavors. In response to the laundry list of challenges, Bryson indentifi es key variables that increase cross-collaborations' success. They include: Wellspring Harvest and WCC practices refl ect and internalization of many of these recommendations. However, just like most things in life, there are factors that can aff ect relationships and even change collaboration's function and purpose. WCC must be fl exible and responsive to such possibilities. "[In Springfi eld] we exhibit pride, we are a close-knit community -people come together when they need too."