Healthy in a Hurry Revisited

During the summer I blogged about food deserts and talked about one solution being tested: using corner or convenience stores to provide access to fruits and vegetables.  This entails a public private partnership in which the store owner makes space for selling fresh produce and posting signage in and outside the store, to promote purchases of these healthy foods by consumers. On the public side, city government 1) provides management consultation to help the store owner get up to speed regarding the handling and sale of perishable produce; 2) assists with establishing a delivery chain to be sure shelf or bin space is continually replenished; 3) supplies low interest financing to offset the costs of store modification; 4) provides local communications and marketing support to build a customer base for the new foods.  The test in Louisville is called Healthy in a Hurry; so far two locations have been established with more being planned.  Photos linked here will give readers better understanding of this concept.

I serve on a team to evaluate the effectiveness of the corner store concept.  We have quickly learned that the enterprise is very complex.  We have considered a number of questions directly related to the operation of Healthy in a Hurry, but also more basic questions about food deserts.  For example, while it is true that low income residents in disadvantaged urban neighborhoods don't have stores selling fresh, high quality produce, and that these residents typically eat unhealthy diets, are those two facts related?  Are the poor diets determined by poor access, or does low consumer demand, as a first cause, provide a market in which full-service grocery stores cannot be successful?  Because we are sold on the value of healthy eating, we assume that if healthy foods are made available in the food desert, so that people are able to make healthy choices, they will.  In the real world, this may not be the case.  Access is a critical resource, but also important are peoples' motivations, decision making, values, and so forth, as well as social norms and interpersonal support for buying and preparing meals with fresh fruits and vegetables.  The evaluation team is discussing ways to obtain answers to some of these questions, but the task at hand is to look for the operation and success of the Healthy in a Hurry stores.

Immediate issues for the stores are the junction between the range of produce sold and the consumer demands of the surrounding neighborhoods.  Those people more favored by life's lottery are accustomed to buying and preparing a wide range of fresh fruits and vegetables.  They have had opportunities to be exposed to many fresh products that might be rarely part of inner city diets.  Some examples are asparagus, egg plant, apricots, and cherry tomatoes.  While a full service grocery store has a large enough customer base that someone will buy anything stocked, in one of these convenience stores, it is more critical to know what people in the neighborhood will actually buy.  A related question is How much can that consumer demand be changed?  Can we, as outsiders, influence the local residents to value and purchase new products not part of their traditional diets?  The answer is a very guarded yes.  Consumer behavior can be changed, but rarely is it a quick process.  In the case of the Healthy in a Hurry project, time is of the essence.  Unless people begin to buy these healthy food choices, the effort is not sustainable and the produce sections will go away, without long term government subsidy.

Other things are being done to enhance the diets of inner city residents.  The public schools are reducing the sugar, fat and salt content of their menus, and expanding the availability of fresh fruits and vegetables.  At the same time, they have begun to limit the selling of junk food from vending machines and school fund-raisers.  In Louisville, there is an effort to support and encourage community gardens: public property on which people can plant small garden plots.  The idea is that anything grown in a garden not only helps family budgets go farther, but usually will be healthier foods than things purchased in packages and cans.

Another strategy which is becoming more and more common is to organize and provide space for urban farmers' markets.  This is a way to bring fresh produce into urban neighborhoods.  Logistical problems include mechanisms to enable the use of credit cards and food stamps for market purchases.  In general, farmers' market fare is more expensive than produce sold in a bog box retail store, though quality is often better.  Nevertheless, price differentials between the farmers' market and a grocery store will be an issue for low income families.

Both of these strategies (community gardens, farmers' markets) are being promoted in Louisville, and many other communities around the U.S.  We don't yet have good data on who participates and how these might actually improve the nutritional status of disadvantaged Americans.

As an innovation, Healthy in a Hurry is an exciting concept.  We need to learn much more about how it contributes to health in the inner city, and how to make these stores the most effective.