This blog post is the follow-up to one written by Tufts student Leah Lazer and I in January 2013, about research we are carrying out to explore available and possible policy and planning tools and techniques that cities can use to promote the sale of fresh, healthy food at corner stores in low-income and minority communities in order to increase food access and food security for local residents (Policy and planning tools for healthy corner stores). Below we present two case examples, one from Washington, DC and the other from Baltimore, MD showing different institutional arrangements.

Case examples

In Washington, DC, the Healthy Corners program is operated by a collaboration of DC Central Kitchen, the DC Department of Health, and initial support from DC Hunger Solutions. In this program, participating corner stores place their produce orders with DC Central Kitchen, who then places the wholesale order and delivers the requested products in their refrigerated truck. This eliminates the barrier that storeowners face when wholesale distributors have minimum orders greater than what their small business can sell before the produce goes bad. For the first few months of the program, DC Central Kitchen sold the produce to the storeowners at a reduced price, allowing them to arrive at a suitable mix and quantity. They also provide nutrition education, cooking demonstrations, marketing support and technical assistance. They are funded through the FEED DC Act of 2010, administered via the DC Department of Small and Local Business Development.

According to Lindsey Palmer, Director of Nutrition and Community Outreach at DC Central Kitchen, lessons from their program have highlighted the importance of building strong relationships with storeowners and the communities, of training both storeowners and consumers in how to store perishable food, of advertising the program initially, and of dispelling the myth that healthy food is prohibitively expensive compared to unhealthier options.

The Baltimore, MD Healthy Stores project is one of the only instances of a corner store program spearheaded by a university – in this case, the Johns Hopkins Bloomberg School of Public Health. According to Joel Gittelsohn, Professor in the Center for Human Nutrition at the Johns Hopkins Bloomberg School of Public Health, the university affiliation has allowed for more academically rigorous evaluation, and provides researchers already that have significant experience in intervention development. Their approach centered on identifying the foods that contribute the most fat, sugar, salt, etc to local residents’ diets using “community workshops”, and then working with corner stores to stock healthier alternatives to those foods, combined with marketing and education strategies to encourage the shift in resident purchasing patterns.

Their experience implementing the intervention demonstrated the need to balance community input with quantitative and qualitative data in constructing a corner store intervention, and revealed the surprisingly large benefit of having an issue champion in the community or government agency. Similarly to DC Central Kitchen, Gittelsohn emphasized the need to publicize the initiative early and often, and to reach out to unexpected partners in places like the city’s Office of Sustainability and religious institutions.

Policies and plans

The variety of methods cities are using to promote the sale of healthy food in corner stores in low-income, minority neighborhoods can be roughly divided in to five mechanisms: advertisement and education, zoning, licensing and permitting, consumer price reduction, and financial support to stores.

Advertisement and education is the approach with the lowest cost and shortest time frame for implementation, making it the most ubiquitous method of support among both government agencies and non-profits. Among the most common forms are providing posters to advertise the healthy wares to passers-by, posters encouraging consumers to make healthy purchases or reminding them of nutritional information and running on-site promotional or educational programming. The greatest cost of this approach is staff hours required to run educational programming.

The zoning process divides a city in to districts and determines what land uses may occur in each type of district, in categories such as residential, commercial, industrial, recreational, etc. Zoning code can be amended to prohibit or make conditional the establishment of food retail that doesn’t meet healthy criteria within a certain distance of a school, residential district or other zone. Zoning can also be amended to exempt healthy food retailers from requirements that may be burdensome to small businesses, such as parking requirements, or can require stores to meet certain healthy criteria or to accept Supplemental Nutrition Assistance Program (SNAP) and Women, Infants and Children (WIC) as a precondition for receiving their land use entitlement. However, as zoning is intended for long-term city planning, existing establishments are often grandfathered in to updated regulations, making it a useful tool for forward-looking design with less immediate potency.

Licensing laws function similarly to zoning codes, but regulates a business’ operations as opposed to the parcel of land it occupies. These policies can use the same tools as in zoning, requiring healthy options or certain locations as a condition for being permitted to operate. Policy approaches using licensing or permitting can produce results more quickly than zoning, because permits often need to be renewed annually.

Financial support to stores can take the form of direct funds, loans or in-kind item distribution to help stores access the new infrastructure required to sell produce. It could cover the expenses for new refrigeration or shelving, a scanner or book-keeping equipment, or improvements to the store’s façade or layout to make it more attractive to customers and direct their attention to the healthier items.

Mechanisms to reduce the price of healthy food in corner stores may be the most complicated but promising approach, as many consumers cite price as a key determinant in their food purchasing habits. This most commonly takes the form of requiring that corner stores accept SNAP and WIC benefits, and some cities have supplemented this with additional SNAP-type benefits to be spent only on healthy food. Other proposed policies tax unhealthy items, using that revenue to subsidize healthy food.

With all policies, it is important to support storeowners in meeting new requirements, because placing burdens on businesses in low-income areas can hamper local economies, is politically unpopular and could prove to be nearly unenforceable, leading to expenses for the government agency with little benefit for the community, according to Christine Fry, a Senior Policy Analyst and Program Director at ChangeLab Solutions in Oakland, CA.

Future research

Future plans for this research including expanding and completing the inventory of policy and planning tools, analyzing them by the policy mechanism employed, the barrier they address, their estimated itemized budget requirements, and examples of current usage. Future case examples will include the San Francisco Bay Area, Boston, and possibly New York City or Philadelphia.

Some questions have recently arisen that could take this research in exciting new directions. As stated, most current corner store initiatives are partnerships between non-profit community organizations and city departments of health. Often, the programs are framed by the non-profits in terms of social justice and community development, but much of the funding and personnel comes from the city government, staffed by professionals with backgrounds focused on epidemiology, nutritional status, or other more technical angles on the same issue. It would be compelling to explore whether this results in the program’s equity aspects being rebranded as public health, whether some cultural sensitivity is lost in the implementation, whether the implementation is refined and organized in ways beyond the capacity of the non-profits, or other ways that this dynamic might impact, positively or negatively, the implementation of corner store programs.

The second interesting question emerges around evaluation of these programs. While most corner store programs publish an informal “lessons learned” piece or some statistics on their program, there is an overall lack rigorous program evaluation of corner store programs for their impacts on public health or economic development. This is largely due to organizations’ impetus to spend as much of their funding as possible on the program itself, rather than on its monitoring or evaluation, to achieve the greatest impact and appear virtuous to peer organizations and funders who deride large overhead costs.

It may also be due to a lack of organizational staff experience with rigorous program evaluation. Evaluative data would help improve these programs moving forward, inform future programs, create greater opportunities for program exposure, and provide a credible, demonstrated record of success in funding applications and in policy advocacy. A worthwhile research question would be to further examine the reasons for lack of evaluation, and find ways to mitigate this problem and encourage assessments. A notable exception to this pattern is in Baltimore, as described above, where Johns Hopkins University has been deeply involved in corner store program implementation and evaluation, resulting in several published articles.

Finally, most corner store initiatives in the program phase could serve as a testing ground for and bridge to corner store policies, which would be more financially sustainable and broadly effective. However, many programs do not see themselves in that role, or do not know how the process of transitioning to a policy could work. Another interesting avenue for research would be investigating how corner store programs see their role in relation to policy, and ways to encourage them to take on a more active role in policy creation.