By Kara Lubischer, University of Missouri Extension and Kay Gasen, University of Missouri – St. Louis
For many Americans, buying healthy foods is as simple as driving a short distance or walking a few blocks to the neighborhood grocery store. For others, especially those in low-income communities, accessing a food retailer with healthful food choices is not so easy. Without supermarkets nearby, residents are dependent on corner stores, gas stations or convenience stores that often lack fresh fruits and vegetables and stock primarily high-priced, high-processed foods, a situation that contributes to the obesity epidemic and other health disparities.
But efforts are underway to encourage corner stores to broaden their inventory of fresh produce, whole grains and low-fat dairy. Due to the positive association between the retail environment and diet, communities across the country have begun working with corner stores, bodegas and rural groceries to make changes that improve both the store environment and the food inventory offered. University of Missouri (MU) Extension launched the St. Louis Healthy Corner Store Project in 2011 through a partnership with the City of St. Louis. The Healthy Corner Store Project works in cooperation with communities and corner store owners to deliver a comprehensive approach that combines community development, small-business support, nutrition education and greater availability of affordable, nutritious foods.
By the numbers:
· The U.S. Department of Agriculture estimates that 23.5 million Americans lack easy access to full-service supermarkets. Widespread evidence shows that low-income communities and the elderly often have disproportionately less access to healthy foods across the country.
· Low-income communities in which residents are unable to easily overcome the geographic disparity between where they live and retailers with healthy food options have commonly been described as food deserts, defined by the U.S. Department of Agriculture (USDA) as areas “with a poverty rate of 20 percent or greater and 33 percent or more of individuals living more than 1 mile in urban areas, and 10 miles in rural areas, away from a supermarket.”
· There are varying results, but a 2010 report stated that researchers find that residents who live near supermarkets or in areas where food markets selling fresh produce (supermarkets, grocery stores, farmers markets, etc.) outnumber food stores that generally do not (such as corner stores) have lower rates of diet-related diseases than their counterparts in neighborhoods lacking food access.
· A 2008 study by the California Center for Public Health Advocacy, PolicyLink, and the UCLA Center for Health Policy Research found that there is a 20 percent higher prevalence of obesity and a 23 percent higher prevalence of diabetes among adults living near corner stores, compared to those who live near supermarkets and produce vendors.
· Corner stores are frequent destinations for children on their way to and from school. A study published in Pediatrics found that the average Philadelphia student purchases more than 350 calories on each visit to the corner store – and 29 percent of them shop at corner stores twice a day, five days a week, consuming almost a pound worth of additional calories each week.
St. Louis Healthy Corner Store Project
The St. Louis Healthy Corner Store Project expands access to affordable, healthy food in existing small food retailers, while also promoting nutrition education and healthy eating among community members. The project offers a comprehensive approach to closing the food gap in any community by engaging both small food retailers (supply) and community residents (demand).
The St. Louis Healthy Corner Store Project is unique in that participation requires the nomination of a store by a community-based organization. The nominating organization serves as a “community leadership team,” with the role of increasing awareness and support and helping to build the demand for healthier foods, thus reducing the risk for store owners. The project provides resources for the community leadership team, starting with an eight-session nutrition course taught by MU Extension educators. Additionally, modest funding is available for events and promotions organized by the community leadership team. Team-sponsored activities have included cooking demonstrations, taste-tests at participating stores, health fairs, teen cooking competitions and a healthy eating poster design contest, with the winning posters hung at the store
Participating stores are required to stock fruits and vegetables, whole grain products, low-fat dairy and snack items, and healthy beverages. Each store owner is paired with a grocery professional, recruited by the St. Louis Development Corporation, who serves as a mentor; together they improve store layout, identify healthy inventory options with existing distributors, identify new suppliers, and organize cooperative buying among retailers. This cooperative purchasing is especially critical when working with produce wholesalers and locally produced value-added items in order to purchase inventory at a lower price. Regular community team meetings are held to plan and share information about upcoming events and get community feedback. Store owners are encouraged to participate in team meetings in order to strengthen the partnership.
Impact is measured in a variety of ways. Neighborhood residents and customers are formally and informally surveyed about their eating habits, their opinions of the participating store, and interest in participating in community health activities. Within each store, customers provide feedback and suggestions on store appearance, current inventory, neighborhood perception, and new food items. Impact is also measured by taking an inventory at the start of the project, at six months and one year into the project. Early evaluation shows that participating stores have increased the percentage of healthy food inventory as much as 25 percent.
The Project also emphasizes the important role of nutrition education. Simply increasing availability to fresh and healthy foods alone is not effective in increasing residents’ intake of these foods. Education must also accompany increased accessibility in order to have a large-scale and lasting impact. Working
Stock Healthy, Shop Healthy
The St. Louis project creates a framework for increasing access to healthy foods that addresses both supply and demand and can be replicated in other areas. MU Extension is now developing resources for stores and communities to develop healthy retail projects across the state as part of the new “Stock Healthy, Shop Healthy” initiative. Toolkits, an accompanying website, assessment tools and a webinar series will share evidence-based practices for increasing access to healthy foods through partnerships between food retail establishments and community organizations.
· A successful healthy retail program engages store owners, community leaders, public health practitioners, nutrition educators and customers. Regardless of the size of a program, a community engagement strategy is vital to the store’s success and addresses both supply and demand with a goal of lessening the potential burden on participating stores. Initial demand created with strong community engagement then lowers the risk to the retailer who will be increasing the store’s supply of healthy inventory.
· Program staff and volunteers that consistently meet with the owners of small food stores are better able to build trust with owners and encourage them to more fully participate in the initiative and to experiment selling different products and healthful food options.
· Many stores face a multitude of distribution obstacles, and addressing such issues remains a challenge for the St. Louis project. Programs that are able to connect small food retailers with produce wholesalers or local producers will significantly contribute to the store’s success. In addition, encouraging cooperative buying of goods for sale among participating small food retailers helps lower the cost of the goods, cost savings which then can be passed onto customers.
· Healthy retail programs are also community and economic development initiatives. New products and more variety will attract new customers, and prominently displayed healthy foods can increase sales. As part of everyday life, rural and urban stores not only provide essential supplies to their customers but also fulfill many other roles – as an employer, economic force and community gathering place.
Borradaile, K. E., Sherman, S., Vander Veur, S. S., McCoy, T, Sandoval, B., Nachmani, J., Karpyn, A., Foster, G.D. (2009). Snacking in Children: The Role of Urban Corner Stores. Pediatrics, 124(5), 1293-1298. doi: 10.1542/peds.2009-0964).
California Center for Public Health Advocacy, PolicyLink, and the UCLA Center for Health Policy Research (2008). Designed for Disease: The Link Between Local Food Environments and Obesity and Diabetes. Davis, CA: California Center for Public Health Advocacy.
Cooperative State Research, Education, and Extension Service of the U.S. Department of Agriculture, the Economic Research Service, and the Food and Nutrition Service (2009). Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences. Report to Congress.
PolicyLink and The Food Trust (2010). The Grocery Gap: Who Has Access to Healthy Foods and Why Does It Matter.
United States Department of Agriculture, Agricultural Marketing Service. “Food Deserts,” http://apps.ams.usda.gov/fooddeserts/foodDeserts.aspx. Accessed August, 23, 2013.