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This Hospital Was Built in a Food Desert—So They Started Selling Groceries

This Hospital Was Built in a Food Desert—So They Started Selling Groceries

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By offering healthy groceries and nutritional services, could all hospitals practice what they preach?

ProMedica is a hospital and healthcare system based in Toledo, Ohio that’s providing more than just routine healthcare to its patients—it also opened up a non-profit grocery store called Market on the Green. The hospital is extending its mission to educate patients about nutrition with a shop located on the ground floor of the Ebeid Institute for Population Health. It's been so successful that ProMedica is expanding the concept elsewhere.

The hospital system's decision to open a full-fledged grocery store was discussed at length in a Supermarket News feature published this week. The director of the ProMedica Ebeid Institute, Anthony Goodwin, told Supermarket News that the hospital's neighborhood "was not only a food dessert...Its residents had poor health outcomes, high emergency room utilization readmissions, and recent chronic illnesses."

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For nearly three years, Market on the Green has provided local patients access to fresh, healthy groceries at affordable prices, with a focus on hyperlocality. Much like other traditional retailers, Market on the Green operates in a spacious 65,000-square-foot store, and it sells produce, poultry, beef, fish, frozen products, dairy, and even pharmacy items and beauty products. “We also have a dollar aisle, carry some general merchandise, and some pet supplies," Branden Ludwig, the store's general manager, told Supermarket News.

Market on the Green also takes time to educate both staff and customers about nutrition—they hire a dietitian to run cooking classes as well as grocery store tours, where shoppers are given healthy cooking tips and are educated on shopping for seasonal produce and reading nutrition labels.

The supermarket staff also offers a public class called "Cooking Matters," where students enroll in a six-week course taught by a professional chef and the dietitian. There, students learn how to cook healthy recipes for a family of four, with ingredients costing less than $10 total. Each participant receives a book of 100 recipes at the end of the course.

“We’re trying to break the stigma that it's too expensive to eat healthy and feed a family,” Goodwin says.

More special programs changing the way we view healthcare:

And because the hospital system owns the grocery market, all of the grocery workers are enrolled in ProMedica's job training program, which focuses on training individuals with barriers to employment (such as the lack of a GED). Supermarket News reports that ProMedica offers resources like educational stipends and professional development programming. Employees spend as little as six months in the program before ProMedica considers them for other roles.

“We connect them with a position within another ProMedica department—nursing, dietary, security, whatever interests them—or with an external partner,” Goodwin tells Supermarket News.

Why would a hospital focus on opening accessible grocery stores, you may ask?

"We think it’s the right thing to do to address poor health outcomes. Our CEO is really visionary," Goodwin says. "While most healthcare systems continue to put more and more money in the 20 percent with the most healthcare costs, he believes we should focus on the rest of the population or we're never going to see these health outcomes improve.”

Because of Market on the Green's initial success over the last three years, the hospital group is opening new outposts in more ZIP codes. In late 2017, ProMedica launched the Mobile Market, which is a 20-foot truck loaded with fresh groceries making stops at more than 25 low-income and senior apartment complexes in the suburbs of Toledo. Goodwin tells Supermarket News that Market on the Green is also launching online order services to bring home delivery to three more areas around Toledo.

With doctors focusing on educating patients about wholesome nutrition in order to prevent chronic illnesses—and in some cases, actually prescribing healthy groceries after visits—the concept of opening a health market on the ground floor of a hospital seems promising.

Meet the workers who put food on America’s tables – but can’t afford groceries

I n the piercing midday heat of southern Texas, farmhand Linda Villarreal moves methodically to weed row after row of parsley, rising only occasionally to stretch her achy back and nibble on sugary biscuits she keeps in her pockets. In the distance, a green and white border patrol truck drives along the levee beside the towering steel border wall.

For this backbreaking work, Villareal is paid $7.25 per hour, the federal minimum wage since 2009, with no benefits. She takes home between $300 and $400 a week depending on the amount of orders from the bodegas – packaging warehouses which supply the country’s supermarkets with fruits and vegetables harvested by crews of undocumented mostly Mexican farm workers.

Villarreal works six days a week, sometimes seven, putting food on Americans’ tables but earns barely enough to cover the bills and depends on food stamps to feed her own family.

Every day is a hustle: she gets up at 4.30am to make packed lunches for her colleagues, charging them $5 each for homemade tacos, before heading to the fields for a 7 o’clock start. She skips breakfast.

Healthcare is a major struggle for farm workers: Villarreal takes diabetes medication a ‘legal’ friend buys from a cheap pharmacy across the border, rather than take time off to attend a non-profit local health clinic. It’s the wrong dose, but better than nothing she reckons.

“I feel like I’m from here, my children are all American, but I don’t have the paperwork, and that makes everything hard,” said Villarreal, 45, wiping the sweat on her long-sleeved hoodie which offers some protection from the harsh sun rays.

Linda Villarreal works six days a week, but barely makes enough to support her family. Photograph: Encarni Pindado/The Guardian

About half of the 2.5 million farm hands in the US are undocumented immigrants, according to the US Department of Agriculture (USDA), though growers and labor contractors reckon the figure is closer to 75%.

Even before the pandemic, farms were among the most dangerous workplaces in the country, where low-paid workers have little protection from long hours, repetitive strain injuries, exposures to pesticides, dangerous machinery, extreme heat and animal waste. Food insecurity, poor housing, language barriers and discrimination also contribute to dire health outcomes for farm workers, according to research by John Hopkins Centre for a Livable Future.

After long days in the fields, Villarreal sleeps on an old couch in the kitchen-lounge as part of the house was left uninhabitable by a fire and a hurricane. Her 11-year-old son, who has ADHD, sleeps on the other couch, while two daughters share a bedroom where water leaks in through the mouldy roof. The eldest, a 16-year-old who wants to be a nurse, and her six-month-old baby sleep in a room with cindered walls. The house is a wreck, but there’s no spare money for repairs.

Many undocumented farm workers have been toiling in the fields for years, pay taxes and have American children, yet enjoy few labor rights, have extremely limited access to occupational health services and live under the constant threat of deportation.

In truth, farm workers here are never harassed while working in the fields, which advocates say suggests a tacit agreement with growers to ensure America’s food supply chain isn’t disrupted by immigration crackdowns. It’s everywhere else that these essential workers, who kept toiling throughout the pandemic, are not safe.

Central American and Mexican migrants work harvesting cabbage in the Rio Grande Valley. Photograph: Encarni Pindado/The Guardian

Last summer, Villarreal (and her three teenage daughters) contracted Covid-19, which left her struggling to breathe. Rather than risk going to an emergency room, a relative with legal immigration status crossed the border to Reynosa and purchased a small tank of oxygen. In the end, Villarreal was off work sick for a month without pay, used up all her savings and took out a loan.

“I should take better care of myself but I don’t have the time and I can’t afford to lose wages.”

Villarreal has lived in the Rio Grande Valley for 26 years and hasn’t set foot in Mexico for the past 19. She’s never had a mammogram or a pap smear.

Food co-ops are on a mission to fix our food system. They might just succeed.

A rendering of the Dorchester Food Coop, which is slated to open in 2021. Cooperatively run food stores offer a chance to revitalize “food deserts” by investing in community as well as in the business of selling food.

While growing up in East Oakland, Daniel Harris-Lucas experienced what can happen after a beloved grocery store closes. He was 13 when the store close to where his family lived shut its doors. They had to travel further to get their groceries at a Safeway. Worse, they lost the connections they’d had to the people who’d worked at the store, and shopped there. For Harris-Lucas and his family, shopping for food suddenly became an impersonal and unsatisfying chore.

Erin Higginbottham (left) is a founding member of the East Oakland Grocery Cooperative.

“It’s not just a store that will pop up out of nowhere and put this pretty little bow on everything,” she says. The central goal of the cooperative is to not just provide food, but to “build generational, holistic wellness.”

Donate to the East Oakland Grocery Cooperative.

More than a decade later, Harris-Lucas carries with him the memory of losing that neighborhood store. It’s one reason he is working to establish a community-centered food store in his old neighborhood. Called the East Oakland Grocery Cooperative, the store is Black-owned and run with the goal of building community by providing “fresh, local and healthy foods and job opportunities to the Black, Indigenous and People of Color (BIPOC) residents of East Oakland,” according to its mission statement.

The store hasn’t opened yet, but the founders-in-training have been distributing food to the neighborhood monthly to get residents involved in supporting its launch.

Cooperatively run food stores have been around since the 18th century when they first cropped up in Europe. But they’ve achieved new relevance in the pandemic, which has pushed people toward local food suppliers. Recent protests against police brutality have driven even greater support.

“Empty grocery shelves made the fragility of the food system and its built-in inequities much more visible,” says Malik Yakini, executive director of the Detroit Black Community Food Security Network (DBCFSN), and co-founder of the Detroit People’s Food Coop. The co-op that has seen a huge surge in member sign-ups over the past few months, whose membership fees will help fund the store’s installation.

As with many cooperatively run stores, the Detroit People’s Food Coop seeks not only to run a successful store but to revitalize the community it is based in. “We want to stock items that are produced in Detroit, they’re processed in Detroit, they’re sold in Detroit,” explains Yakini. “We employ people who live in Detroit, who take the money they earn from sales and spend it in Detroit.”

The goal, says Yakini, is to keep wealth in the neighborhood. “We expect our co-op to have an impact on the local food economy more generally.”

This commitment to community-building and the local circulation of wealth is why a food co-op is also seen by many as a means of redressing a longstanding problem with our food system: the country’s failure to make healthy food easily available across the country.

Pockets of food scarcity, traditionally known as food deserts, have long been blamed on the absence of supermarkets. In 2015, the USDA estimated that 19 million people, or 6.2 percent of the US population, lived in a food desert. The Food Trust reports these are much more likely to occur in communities of color. One reason for this is a practice known as redlining, a federal housing policy from the 1930s that blocked Black families from receiving home loans. As more affluent residents fled to the suburbs in the ‘60s and ‘70s, many supermarket chains followed. For decades, supermarket redlining left large numbers of poor and disadvantaged residents without easy access to healthy food.

Founding members of the East Oakland Grocery Cooperative. Left to right: Erin Higginbotham, Jameelah Lane, Yolanda Romo, and Daniel Harris-Lucas. Photo credit: Kelly Carlisle.

“I can show you the one grocery store we have,” says Daniel Harris-Lucas. “But I can also show you our five liquor stores. The real question is why do we only have this one, and if this one grocery store closes, will we get a new grocery store immediately?”

His effort to open a cooperatively-run store seeks to safeguard the community against this uncertainty.

But solving the food scarcity issue is no longer seen as a simple case of opening up more grocery stores. Researchers have found that when a large grocery store opens in an impoverished community, it doesn’t necessarily change how people eat. According to a recent study in the Quarterly Journal of Economics, people may shop at a new supermarket, but they buy the same groceries they had been buying before.

Eating healthy foods depends on income, researchers concluded, more than access. And processed foods, which have been linked to obesity, diabetes, and heart disease, are the cheapest foods available, thanks largely to government subsidies for commodity crops. Food desert neighborhoods, filled with liquor and convenience stores, are dominated by these kinds of foods, leading some to call them food swamps.

“‘Food desert’ sugarcoats what the problem is,” says veteran food justice activist Karen Washington. “If you bring a supermarket in, it’s not going to change the problem. When we say ‘food apartheid’, the real conversation can begin.” Washington says that food apartheid “brings us to the more important question: what are some of the social inequalities that you see, and what are you doing to erase some of the injustices?”

Unlike a Safeway or an Albertsons, food co-ops are well-suited to tackling the inequities that limit access to healthy food for so many. Co-ops tend to be mission oriented and informed by a concern for people, democracy, and education. They often function as community centers, maintain libraries and educational kitchens, hold events, run low-income assistance programs, and partner up with community partners to offer discounts. A co-op is also responsive to what its community wants because members—the shoppers themselves—control how it’s run.

Liz Wang (far right) is a board member of the Dorchester Community Coop in Boston. In nine years of organizing, she became well aware of the stigma held by certain co-ops.

“Co-ops had a reputation of serving communities that had higher incomes and less diversity, mostly white. This perception was common, despite the fact that coops have their roots in serving low-income and disempowered communities. Many started in the 1930s during the Great Depression, and we have so many examples of amazing Black-led co-operatives.”

Donate to the Dorchester Community Coop

These close neighborhood connections may help explain why a 2019 Next City survey of 71 food stores that have opened since 2000, found that all 22 of the community-run food co-ops survived. Out of the rest, half the commercial stores and a third of the government developments had closed.

It doesn’t hurt that food co-ops are also an economic force to be reckoned with. More than 300 food co-ops exist across the country, with another 80 under development. In 2017, the sector generated more than two billion in sales, 20 percent of which came from local products.

Not all food co-ops are the same, of course. Some focus on more expensive organic items and cater to wealthy white neighborhoods. While they often work hard to improve access to their food, this is different from a co-op born in a marginalized neighborhood out of a community need for any kind of fresh food.

And for all the benefits of food co-ops, deploying more of them to underserved communities isn’t a no-brainer solution. Without the financial backing large retailers have, building one takes an immense amount of work. The People’s Food Coop, for instance, was fortunate to have the city of Detroit on its side. The Detroit Housing and Revitalization Department helped the co-op secure a location, but only after raising the hefty $13 million it needed to build the Detroit Food Commons, and a lot of grassroots organizing.

The Detroit People’s Food Coop building will house the co-op along with several incubator kitchens for start-up entrepreneurs, a community meeting space, and offices for the DBCFSN. The plan is for the commons to become a hub for the neighborhood, and attract like-minded businesses. Another focus of the co-op is education it plans to roll out classes on nutrition, food preparation, diet, as well as issues of food justice. To anchor its business in the community, the co-op has held more than 40 engagement sessions, movie nights, and game nights. Photo source: Detroit People’s Food Coop

The Renaissance Community Coop (RCC) in Greensboro, NC, is a typical example of the kinds of challenges independent retailers face. It operated for two years before closing its doors due to a low sales volume, fierce corporate competition, and lack of operational capacity. But instead of just walking away, the founders took the closure as an opportunity to write about the failure in hopes of inspiring success elsewhere.

“Movement-building is your secret weapon,” they wrote. “You have it, and your corporate competitors do not.” A better food system hinges on building this kind of community involvement. For all its shortcomings, “we are situating RCC’s failure as just one step in a longer struggle to build a more democratic, just, and sustainable economy—one grocery store at a time.”

One store at a time may not be fast enough for some. But for many co-op founders, focused as they are on working within their own neighborhoods, it’s a more sustainable way to bring about change in long-marginalized areas.

“Co-ops become the only solution that I’m aware of, within the context of a capitalist system, where groups can organize their economic strength collectively and also benefit collectively,” said Malik Yakini. “The broad benefit that comes from broad ownership doesn’t exist in American economic society in any other form.”

Alec Tilly is a News Fellow based in San Francisco, CA.


By 1973, the term "desert" was ascribed to suburban areas lacking amenities important for community development. [9] A report by Cummins and Macintyre states that a resident of public housing in western Scotland supposedly coined the more specific phrase "food desert" in the early 1990s. [10] The phrase was first officially used in a 1995 document from a policy working group on the Low Income Project Team of the UK's Nutrition Task Force. [10]

Initial research was narrowed to the impact of retail migration from the urban center. [11] More recent studies explored the impact of food deserts in other geographic areas (e.g., rural and frontier) and among specific populations, such as minorities and the elderly. These studies address the relationships between the quality (access and availability) of retail food environments, the price of food, and obesity. Environmental factors can also contribute to people's eating behaviors. Research conducted with variations in methods draws a more complete perspective of "multilevel influences of the retail food environment on eating behaviors (and risk of obesity)." [11]

Researchers employ a variety of methods to assess food deserts including directories and census data, focus groups, food store assessments, food use inventories, geographic information system (GIS), interviews, questionnaires and surveys measuring consumers' food access perceptions. [12] Differences in the definition of a food desert vary according to the:

  • type of area, urban or rural [13]
  • economic barriers and affordability of accessing nutritious foods, including the cost of transportation, price of foods, and incomes of those in the area [10][12][14]
  • distance to the nearest supermarket or grocery store [15]
  • number of supermarkets in the given area [15]
  • type of foods offered, whether it be fresh or prepared [10][12]
  • nutritional values of the foods offered [16]

The multitude of definitions that vary by country has fueled controversy over the existence of food deserts. [12]

It should also be noted that because it is too costly to survey the types of foods and prices offered in every store, researchers use the availability of supermarkets and large grocery stores (including discount and super-center stores) as a proxy for the availability of affordable, nutritious food. [17]

Distance Edit

Distance-based measurements are used to measure food accessibility in order to identify food deserts.

The United States Department of Agriculture (USDA) Economic Research Service measures distance by dividing the country into multiple 0.5 km square grids. The distance from the geographic center of each grid to the nearest grocery store gauges food accessibility for the people living in that grid. [18] [19] Health Canada divides areas into buffer zones with people's homes, schools or workplaces as the center. The Euclidean distance, another method to measure distance, is the shortest distance between the two points of interest, which is measured for gaining food access data, despite the fact that it is a less effective distance metric than the Manhattan Distance. [18] [20]

Different factors are excluded or included that affect the scale of distance. The USDA maintains an online interactive mapping tool for the United States, the "Food Access Research Atlas," which applies four different measurement standards to identify areas of low food access based on distance from the nearest supermarket. [21]

The first standard uses the original USDA food desert mapping tool "Food Desert Locator" and defines food deserts as having at least 33% or 500 people of a census tract's population in an urban area living 1 mile (10 miles for rural area) from a large grocery store or supermarket. [18] [22]

The second and third standards adjust the scale of distance and factor income to define a food desert. In the U.S., a food desert consists of a low-income census tract residing at least 0.5 miles (0.80 km) in urban areas (10 miles (16 km) in rural areas) or 1 mile (1.6 km) away in urban areas (20 miles in rural areas) from a large grocery store. [21] The availability of other fresh food sources like community gardens and food banks are not included in mapping and can change the number of communities that should be classified as food deserts. [23] A 2014 geographical survey found that the average distance from a grocery store was 1.76 kilometers (1.09 miles) in Edmonton, but only 1.44 kilometers (0.89 miles) when farmers' markets and community gardens were included, making it 0.11 miles under the latter definition for an urban food desert. [24]

The fourth standard takes vehicular mobility into account. In the U.S., a food desert exists if 100 households or more with no vehicle access live at least 0.5 miles (0.80 km) from the nearest large grocery store. For populations with vehicle access, the standard changes to 500 households or more living at least 20 miles (32 km) away. [21] [25] Travel duration and mode may be other important factors. [26] As of 2011, public transport is not included in mapping tools. [23]

Fresh food availability Edit

A food retailer is typically considered to be a healthful food provider if it sells a variety of fresh food, including fruits and vegetables. Types of fresh food retailers include:

Food retailers like fast-food restaurants and convenience stores are not typically in this category as they usually offer a limited variety of foods that could constitute a healthy diet. [18] Frequently, even if there is produce sold at convenience stores it is of poor quality. [27] A "healthy" bodega, as defined by the New York City Department of Health and Mental Hygiene, stocks seven or more varieties of fresh fruits and vegetables and low-fat milk. [28]

Different countries have different dietary models and views on nutrition. These distinct national nutrition guides add to the controversy surrounding the definition of food deserts. Since a food desert is defined as an area with limited access to nutritious foods, a universal identification of them cannot be created without a global consensus on nutrition.

Income and food prices Edit

Other criteria include affordability and income level. According to the USDA, researchers should "consider . [the] prices of foods faced by individuals and areas" and how "prices affect the shopping and consumption behaviors of consumers." [29] One study maintains that estimates of how many people live in food deserts must include the cost of food in supermarkets that can be reached in relation to their income. [26]

For instance, in 2013, Whole Foods Market opened a store in the New Center area of Detroit, where one-third of the population lives below the poverty line. Whole Foods is known for its more expensive healthy and organic foods. In order to attract low income residents, the Detroit store offered lower prices compared to other Whole Foods stores. [30] If Whole Foods had not lowered the prices, residents would not be willing to shop there and that area of Detroit would still be considered a food desert.

The difference between a rural and an urban food desert is the population density of residents and their distance from the nearest supermarket. Twenty percent of rural areas in the U.S. are classified as food deserts. [31] There are small areas within each state in the U.S. that are classified as rural food deserts, but they occur most prominently in the Midwest [32] Within these counties, approximately 2.4 million individuals have low access to a large supermarket. [21] [33] This difference in distance translates into pronounced economic and transportation differences between the rural and urban areas. [34] [35] Rural food deserts are mostly the result of large supermarket stores that move into areas and create competition that is impossible for small businesses to keep up with. The competition causes many small grocers to go out of business. This makes the task of getting nutritious, whole ingredients much more difficult for citizens who live far away from large supermarket stores. [36]

In most cases, people who live in rural food deserts are more likely to lack a high school degree or GED, experience increased poverty rates, and have lower median family income. People who live in rural food deserts also tend to be older. This is due to an exodus of young people (ages 20–29) who were born in these areas and decided to leave once they are able. [32]

Based on the 2013 County Health Ratings data, residents who live in rural U.S. food deserts are more likely to have poorer health than those who live in urban food deserts. People who live in rural communities have significantly lower scores in the areas of health behavior, morbidity factors, clinical care, and the physical environment. Research attributes these discrepancies to a variety of factors including limitations in infrastructure, socioeconomic differences, insurance coverage deficiencies, and a higher rate of traffic fatalities and accidents. [37]

In a 2009 study, it was discovered that of the people polled, 64% did not have access to adequate daily amounts of vegetables, and 44.8% did not have access to adequate daily amounts of fruits. Comparatively, only 29.8% of those polled lacked access to adequate protein. This lack of access to fruits and vegetables often results in vitamin deficiencies. This eventually causes health problems for those who live within these areas. [32] When tasked with finding a solution to this problem, research has shown that it will take individual and community actions, as well as public policy improvements, to maintain and increase the capacity of rural grocery stores to provide nutritious, high quality, affordable foods while being profitable enough to stay in business. [32]

Although personal factors do impact eating behavior for rural people, it is the physical and social environments that place constraints on food access, even in civically engaged communities. Food access may be improved in communities where civic engagement is strong, and where local organizations join in providing solutions to help decrease barriers of food access. Some ways communities can do this is by increasing access to the normal and food safety net systems and by creating informal alternatives. Some informal, communal alternatives could be community food gardens and informal transportation networks. Further, existing federal programs could be boosted through greater volunteer involvement. [36]

A 2009 study of rural food deserts found key differences in overall health, access to food, and the social environment of rural residents compared to urban dwellers. [36] Rural residents report overall poorer health and more physical limitations, with 12% rating their health as fair or poor compared to 9% of urban residents. [36] They believed their current health conditions were shaped by their eating behaviors when the future chronic disease risk was affected by the history of dietary intake. [36] Moreover, the 57 recruited rural residents from Minnesota and Iowa in one study perceived that food quality and variety in their area were poor at times. [36] The researchers reached the conclusion that, for a community of people, while food choice which bound by family and household socioeconomic status remained as a personal challenge, social and physical environments played a significant role in stressing and shaping their dietary behaviors. [36]

Food deserts occur in poor urban areas when there is limited or no access to healthful, affordable food options. [38] Low income families are more likely to not have access to transportation so tend to be negatively affected by food deserts. [38] An influx of people moving into these urban areas has magnified the existing problems of food access. [39] While urban areas have been progressing in terms of certain opportunities, the poor continue to struggle. [39] As people move to these urban areas they have been forced to adopt new methods for cooking and acquiring food. [39] Adults in urban areas tend to be obese, but they have malnourished and underweight children. [39] For many people, the reason they cannot get nutritious food is because of a lack of supermarkets or grocery stores [26] When supermarkets are inaccessible it has been shown that vegetable and fruit consumption is lower. [38] When prices are high and there is a lack of financial assistance, many living in places with limited grocery stores find themselves in a situation where they are unable to get the food they need. [40] Another domain to food deserts is that they also tend to be found where poor minority communities reside. [40] Sometimes the issue with urban food deserts is not the lack of food in the area, but rather not enough nutritional knowledge about food. [41]

According to research conducted by Tulane University in 2009, 2.3 million Americans lived more than one mile away from a super market and did not own a car. [42] For those that live in these urban food deserts oftentimes they do not have access to culturally appropriate foods. [42] For many people, who have health restrictions and food allergies, the effects of food deserts are further compounded. [42] The time and cost it takes for people to go to the grocery store makes fast food more desirable. [42] There is also a price variance when it comes to small grocery stores that affect people in lower income areas from purchasing healthier food options. Smaller grocery stores can be more expensive than the larger chains. [42]

Oftentimes urban food deserts are applied to North America and Europe, however in recent years the term has been extended to Africa as well. It has taken time for researchers to understand Africa's urban food deserts because the conventional understanding of the term must be reevaluated to fit Africa's unconventional supermarkets. [42] There are three categories for food deserts: ability-related, assets-related, and attitude-related. [42] Ability-related food deserts are “anything that physically prevents access to food which a consumer otherwise has the financial resources to purchase and the mental desire to buy”. [42] An asset-related food desert involves the absence of financial assets, thus preventing consumption of desirable food that is otherwise available. [42] Lastly there are attitude-related food deserts any state of mind that prevents the consumer from accessing foods they can otherwise physically bring into their home and have the necessary assets to procure. [42] In Cape Town, South Africa supermarkets take up a large portion of retail space. [42] While supermarkets are expanding in poor neighborhoods in Cape Town, their food insecurity is growing at an alarming rate. [42] This is one of the biggest road blocks when understanding food deserts. Based on the European or American understanding of food deserts the fact that there is access to supermarkets by definition would mean that Cape Town does not suffer from food deserts. [42] Not only does Africa suffer from food deserts, but there is a direct link between climate change and the rapid growth of food deserts. [42] While supermarkets are expanding to areas that once did not have supermarkets there is still a disparity when it comes to physical access. [42] In the city of Cape Town asset-related urban food deserts are the main reason for the food insecurity, where people in this area are unable to afford the food that they would prefer to eat. [42]

Climate change plays an important role in urban food deserts because it directly affects accessibility. The main way that climate change affects food security and food deserts is that it reduces the production of food. [42] With limited availability of a product the price rises making it unavailable to those that cannot afford more expensive commodities. [42] In Cape Town specifically supermarkets rely directly on fresh produce from the nearby farm area. [42] Not only does climate change affect the production of food, but it can also damage capital assets that affect accessibility and utilization. [42] Specifically in Cape Town the access to food deserts does not change the severity of food deserts. [42] With limited diversity in their diets those that live in Cape Town are highly dependent on foods of low nutritional value and high calorific value. [42] Utilizing the European or American definition of food deserts does not take into account the dynamic market of other cultures and countries.

Crime plays an important role in food deserts. Where businesses cannot operate safely they tend to close, or relocate to more stable areas. Operating a business in a high crime area is more costly than doing so in a stable area, as security can be a significant cost. Periods of civil unrest can accelerate the flight of businesses in areas where the expectation of safe operation is low. [43] Following the 2020 riots, Chicago had more food deserts than before. [44] North American urban food deserts are the result of stores closing due to unprofitability, not due to companies refraining from entering a potential market area. [45]

The primary criterion for a food desert is its proximity to a healthy food market. When such a market is in reach for its residents, a food desert ceases to exist. But this does not mean that residents will now choose to eat healthy. A longitudinal study of food deserts in JAMA Internal Medicine shows that supermarket availability is generally unrelated to fruit and vegetable recommendations and overall diet quality. [ citation needed ]

The availability of unhealthy foods at supermarkets may affect this relationship because they tempt customers to purchase precooked foods which tend to contain more preservatives. Supermarkets may have such an adverse effect because they put independently owned grocery stores out of business. Independently owned grocery stores have the benefit of being made of the community so they can be more responsive to community needs. [42] Therefore, simply providing healthier food access, according to Janne Boone-Heinonen et al., cannot completely eliminate food deserts, this access must be paired with education. [46] [47]

In a 2018 article in Guernica, Karen Washington states that factors beyond physical access suggest the community should reexamine the word food desert itself. She believes "food apartheid" more accurately captures the circumstances surrounding access to affordable nutritious foods. Washington says, "When we say food apartheid the real conversation can begin." [48]

Access to food options is not the only barrier to healthier diets and improved health outcomes. Wrigley et al. collected data before and after a food desert intervention to explore factors affecting supermarket choice and perceptions regarding healthy diet in Leeds, United Kingdom. Pretests were administered prior to a new store opening and post-tests were delivered 2 years after the new store had opened. The results showed that nearly half of the food desert residents began shopping at the newly built store, however, only modest improvements in diet were recorded. [49]

A similar pilot study conducted by Cummins et al. focused on a community funded by the Pennsylvania Fresh Food Financing Initiative. They conducted follow up after a grocery store was built in a food desert to assess the impact. They found that "simply building new food retail stores may not be sufficient to promote behavior change related to diet." [49] Studies like these show that living close to a store stocked with fruits and vegetables does not make an impact on food choices. [49]

A separate survey also found that supermarket and grocery store availability did not generally correlate with diet quality and fresh food intake. [42] Pearson et al. further confirmed that physical access is not the sole determinant of fruit and vegetable consumption. [49]

Work and family Edit

People who have nonstandard work hours, including rotating or evening shifts may have difficulty shopping at stores that close earlier and instead opt to shop at fast food or convenience stores that are generally open later. [23] [49] Under welfare-to-work reforms enacted in 1996, a female adult recipient must log 20 hours a week of "work activity" to receive SNAP benefits. [50] If they live in a food desert and have family responsibilities, working as well may limit time to travel to obtain nutritious foods as well as prepare healthful meals and exercise. [50]

Safety and store appearance Edit

Additional factors may include how different stores welcome different groups of people [23] and nearness to liquor stores. [51] Residents in a 2010 Chicago survey complained that in-store issues like poor upkeep and customer service were also impediments. [51] Safety can also be an issue for those in high crime areas, especially if they have to walk carrying food and maybe also with a child or children. [51]

Fast food Edit

A possible factor affecting obesity and other "diet-related diseases" is the proximity of fast-food restaurants and convenience stores compared to "full-access" grocery stores. [18] Proximity to fast-food restaurants correlates with a higher BMI, while proximity to a grocery store correlates with a lower BMI, according to one study. [18]

A 2011 review used fifteen years of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study to examine the fast-food consumption of more than 5,000 young American adults aged 18–30 years in different geographic environments. [42] The study found that fast-food consumption was directly related to the proximity of fast food restaurants among low-income participants. The research team concluded that "alternative policy options such as targeting specific foods or shifting food costs (subsidization or taxation)" may be complementary and necessary to promote healthy eating habits while increasing the access to large food stores in specific regions and limit the availability of fast-food restaurants and small food stores. [42] Some cities already restrict the location of fast-food and other food retailers that do not provide healthy food. [52]

Fast-food restaurants are disproportionately placed in low-income and minority neighborhoods and are often the closest and cheapest food options. [42] "People living in the poorest SES areas have 2.5 times the exposure to fast-food restaurants as those living in the wealthiest areas". [53] Multiple studies were also done in the US regarding racial/ethnic groups and the exposure to fast-food restaurants. One study in South Los Angeles, where there is a higher percentage of African Americans, found that there was less access to healthier stores and more access to fast food compared to West Los Angeles, which has a lower African American population. In another study in New Orleans, it was found that communities that were predominantly African American had 2.4 fast-food restaurants per square mile while predominantly white neighborhoods had 1.5 fast-food restaurants per square mile. [54] Researchers found that fast-food companies purposely target minority neighborhoods when conducting market research to open new fast-food restaurants. Existing segregation makes it easier for fast-food companies to identify these target neighborhoods. This practice increases the concentration of fast-food restaurants in minority neighborhoods. [55]

Behavior and social and cultural barriers Edit

The likelihood of being food insecure for Latinos is 22.4%, for African Americans 26.1% and for whites, 10.5%. [56] People who are food insecure often will find themselves having to cut back more at the end of the month when their finances or food stamps run out. Month to month, there are other special occasions that may warrant higher spending on food such as birthdays, holidays, and unplanned events. [57] Because people who are food insecure are still fundamentally involved in society, they are faced with the other stressors of life as well as the additional frustration or guilt that comes with not being able to feed themselves or their family. [57]

Other studies have documented a sense of loyalty towards the owners of neighborhood convenience stores as an explanation as to why residents may not change their shopping behaviors. [12]

Steven Cummins also proposed that food availability is not the problem: it is eating habits. [58] Pearson et al. urge food policy to focus on the social and cultural barriers to healthy eating. [59] For instance, New York City's public-private Healthy Bodegas Initiative has aimed to encourage bodegas to carry milk and fresh produce and residents to purchase and consume them. [60]

Pharmacies Edit

In addition to the close proximity of fast-food restaurants and convenience stores, many lower-income communities contain a higher prevalence of pharmacies when compared to medium or high-income communities. [61] These stores often contain a high number of snack foods, such as candy, sugary beverages, and salty snacks that are within arms reach of a cash register in 96% of pharmacies. [62] While pharmacies are important in these communities, they act as yet another convenience store, further exposing low-income residents to non-nutritional food.

Recommended Caloric Intake according to US Department of Agriculture (USDA) [63]
Age Group Gender Recommended Calories
Young Children Boy/Girl 1000-2000
Adolescent Boy/Girl1400-3200 (depending on physical activity)
Adult Female 1600-2400
Adult Male 2000-3200

Regardless of daily caloric intake, if a person does not eat foods that are rich in vitamins and nutrients they are susceptible to diseases related to malnutrition. These diseases include scurvy which results from low vitamin C levels, rickets from low vitamin D levels, and pellagra from insufficient nicotinic acid. [64] Nutrient imbalances can affect a person, especially a developing child in a multitude of ways. Studies show that malnutrition in children can cause problems with academic performance, attention span, and motivation. [65]

Since 2006, the United States has seen an increase in cases of obesity. [66] There are not accessible grocery stores in many food deserts, so people do not have the option of eating fresh produce. Instead, they have access to cheap, fast, and easy food which typically contains excess fats, sugars, and carbohydrates. Examples of such foods include chips, candy, and soda. Several diseases can result from consuming large amounts of these unhealthy food options, including cardiovascular disease, hypertension, diabetes, osteoporosis ,and even cancer. [67]

Fresh produce provides the body with nutrients that help it function effectively. Vegetables are good sources of fiber, potassium, folate, iron, manganese, choline, and vitamins A, C, K, E, B6 and many more. [63] Fruits are good sources of fiber, potassium, and vitamin C. The USDA recommends eating the whole fruit instead of fruit juice because juice itself has less fiber and added sugars. [63] Dairy products contain nutrients such as calcium, phosphorus, riboflavin, protein, and vitamins A, D and B-12. Protein, a good source of vitamin B and lasting energy, can be found in both plant and animal products. [63] The USDA also suggests to limit the percentage of daily calories for sugars (<10%), saturated fats (<10%) and sodium (<2300 mg). [63] Although small amounts of sugars, fats, and sodium are necessary for the body, they can lead to various diseases when consumed in large amounts.

Processed foods Edit

Even knowing the importance of nutrition, an additional barrier people may face is whether they even have the choice. Corner stores often only carry processed food, eliminating the choice of eating fresh. Processed food encompasses any type of food that has been modified from its original state whether from washing, cooking, or adding preservative or other additives. Because it is such a general category, processed foods can be broken down into four more specific groups: "unprocessed or minimally processed foods, processed culinary ingredients, processed foods (PFs), and ultra-processed foods and drinks (UPFDs)." [68]

The original motivation for processing foods was to preserve them so there would be less food waste and there would be enough food to feed the population. [66] By canning or drying fruits and vegetables to try and preserve them, some of the nutrients are lost and oftentimes sugar is added, making the product less healthy than when it was fresh. Similarly, with meats that are dried, there is salt added to help in preservation but results in the meat has a higher sodium content. [66] The ultra-processed foods were not made to be nutrient-rich, but rather to satisfy cravings with high amounts of salts or sugars, so they result in people eating more than they should of food that has no nutritional value. [68] On the other hand, processed foods may be artificially enriched with food additives to include nutrients that many people are lacking in their diets, which may in some cases make up, to some extent, for a lack of fresh food. [69] Some nutritionists may recommend eliminating processed foods from diets, while others see it as a way to reduce food scarcity and malnutrition. [66] In 1990 the Nutrition Labeling and Education Act required nutrition facts labels on food, making it so people could see what and how much of something they were consuming. With that labeling what some companies did was list things that were not added on the front, but rarely did they add information about nutrients they added. [66] Some scientists and nutritionists are looking into ways to create affordable, processed foods that are high in essential nutrients and vitamins and also taste good so the consumer is inclined to buy them. [66]

In low income urban areas, accessibility to fast food restaurants is sometimes better than accessibility to supermarkets. [70]

Alcohol Edit

Many areas that are food deserts have disproportionately high numbers of liquor stores. For example, East Oakland has 4 supermarkets and 40 liquor stores. [71] These communities are also often predominantly populated by ethnic minorities. Both Latinos and African Americans are predisposed to disease resulting from alcohol consumption. Some alcohol-related illnesses include stroke, hypertension, diabetes, colon and GI cancer, and obesity. Some studies show that moderating one's alcohol consumption can reduce one's chance of getting cardiovascular disease and even extend one's mental stability into old age. [67]

Self-care is an essential component in the management of chronic conditions and for those who are healthy. Self-care is greatly influenced by food choices and dietary intake. [67] Limited access to nutritious foods in food deserts can greatly impact one's ability to engage in healthy practices. Access, affordability, and health literacy are all social determinants of health, which are accentuated by living in a food desert. [12] There are two main health implications for those living in food deserts: overnutrition or undernutrition. [67] The community may be undernourished, due to no access to food stores. The community may be over-nourished due to a lack of affordable supermarkets with whole foods and a higher concentration of convenience stores and fast-food restaurants that offer prepackaged foods often high in sugar, fat, and salt. [67] Food-insecurity remains a problem for many low-income families, but the greatest challenge to living in a food desert is poor diet quality. Living in a food desert contributes to a higher prevalence of chronic diseases associated with being overweight. [67] Persons living in a food desert often face barriers to self-care, particularly in accessing resources needed to change their dietary habits.

Transportation and geography Edit

People tend to make food choices based on what is available in their neighborhood. In food deserts there is often a high density of fast-food restaurants and corner stores that offer prepared and processed foods. [5]

In rural areas, food security is a major issue. Food security can imply either a complete lack of food, which contributes to undernourishment, or a lack of nutritious food, which contributes to over-nourishment. [5]

According to the United States Department of Agriculture (USDA), [72] community food security "concerns the underlying social, economic, and institutional factors within a community that affect the quantity and quality of available food and its affordability or price relative to the sufficiency of financial resources available to acquire it." [73] Rural areas tend have higher food insecurity than urban areas. This insecurity occurs because food choices in rural areas are often restricted because transportation is needed to access a major supermarket or a food supply that offers a wide, healthy variety of foods, versus smaller convenience stores that do not offer as much produce. [73]

It is critical to look at car ownership in relation to the distance and number of stores in the area. Distance from shops influences the quality of food eaten. [5] A vehicle or access to public transportation is often needed to go to a grocery store. When neither a car nor public transportation is available, diets are rarely healthy. This is because fast food and convenience stores are easier to access and do not cost much money or time. Further, those who walk to food shops typically have poorer diets, which has been attributed to having to carry shopping bags home. [5]

Adherence Edit

Long-term adherence to a healthful, balanced diet is essential to promote the well-being of individuals and society. Many approaches to helping people eat a healthy, balanced diet are ineffective because of "adherence problems" with behavior changes. [74] Dietary adherence is influenced by habits that develop over a lifetime. [8]

It is especially difficult to "adhere" to a prescribed diet and lifestyle (ex. low-salt diet, low-fat diet, low-carbohydrate diet, low-sugar diet) when living in a food desert without enough access to items needed. When high-sugar, high-fat, and high-salt items are the only foods available to people living in a food desert, dietary adherence requires (a) shift in lifestyle/eating habits and (b) access to fresh, healthy, affordable foods. [8]

Decision-making Edit

Decision-making is an important component of self-care that is affected by food deserts. People employ both rational and naturalistic decision-making processes on a routine basis. Naturalistic decisions occur in situations where time is limited, stakes are high, needed information is missing, the situation is ambiguous and the decision-maker is uncertain. Rational decisions are more likely when people have time to weigh options and consider the consequences. [75]

The way individuals living in a food desert make decisions about healthy eating is influenced by a variety of factors. Communities with higher than state average poverty statistics often report low access to affordable food, thus limiting their ability to maintain a healthy diet. [15] For these families living in poverty, many people work multiple jobs with rotating or evening shifts that make it difficult to find time to shop for food. [7] [76] Time constraints affect decision-making and people often choose to go to a closer convenience store rather than travel farther for fresh food. [77] Families in urban food deserts may lack access to a car, which adds to the time needed to shop for groceries. [8] Additionally, convenience stores and corner stores are typically open later hours than traditional grocery stores, making them more accessible. [78]

Another factor that impacts those living in a food desert is safety. High rates of crime are a barrier for those living in food deserts. [79] If people feel unsafe traveling farther to a grocery store, they are more likely to decide to purchase less healthy options at a closer location. In this way, people prioritize their safety over fresh, healthy foods. [79]

Proximity to fast-food restaurants also influences decisions made when choosing meals. How close an individual is to a fast food restaurant is correlated to having a higher BMI, while proximity to a grocery store is associated with a lower BMI. [80] One study found that people living in the poorest areas of the country have more than twice the exposure to fast-food restaurants compared to people living in wealthy areas. [81] Another study used 15 years of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study to examine the fast-food consumption of more than 5,000 young American adults aged 18–30 years in different geographic areas of the US. [46] Proximity to fast food or a supermarket/grocery store was used to predict the type of food consumed. [46] In low-income study participants, the type of food consumed was directly related to the proximity of fast food restaurants. [46] These results suggest that low-income persons living in a food desert make decisions to consume fast-food based on proximity to fast-food restaurants versus distances to a grocery store. [46]

Health literacy Edit

While access poses a major barrier to the practice of self-care in food deserts, health literacy remains a common barrier to nutritional behavioral choices. Health literacy and food deserts can affect all sectors of the population, but it is known that they both disproportionately affect underserved, low-income individuals. [82] Health literacy is the ability to obtain, read, understand, and use health information in order to make appropriate health decisions and follow instructions for treatment. [83] Health literacy affects the ability to perform self-care by influencing decision-making and relationships with health care professionals. Additionally, health literacy and self-efficacy can predict the likelihood of reading food labels, which predicts dietary choices. [84] A study of young adults in a metropolitan area found that those with low health literacy used food labels significantly less than a high health literacy group, suggesting that low health literacy may negatively influence dietary quality. [84] Overall, this data suggests that health literacy is a key factor in explaining differences in dietary habits, as healthy eating is associated with higher nutrition literacy skills. [85] [86]

When considering health literacy and dietary self-care behavior, a study of persons with heart failure found that those with low health knowledge had poor self-care behaviors. [87] This study reveals how health literacy influences one's ability to manage a health condition and make healthy choices. Gaining access to fresh and affordable food is essential to improving health and decreasing social disparities in those living in food deserts. Increasing health education and resources to improve health literacy are also vital for individuals to engage in healthy behaviors, adhere to dietary recommendations, and practice self-care.

All of the aforementioned limitations to nutritional foods have serious consequences for marginalized groups, as they are disproportionately represented in food deserts. Subsequently, dietary-related diseases continue to have a proportionately large impact in these communities. This can be seen in studies examining diabetes and lactose intolerance. 4.9 million non-Hispanic African Americans aged 20 years or older have diagnosed diabetes, according to the Centers for Disease Control (CDC) national survey data. In the United States, some degree of lactose indigestion occurs in an estimated 15% (6% to 19%) of Caucasians, 53% of Mexican Americans, 62% to 100% of Native Americans, 75-80% of African Americans, and 90% of Asian Americans. [88] Additionally, racial and ethnic minorities have a higher prevalence of diabetes as compared to whites, and have a higher rate of complication post-diabetes diagnosis. [89]

Great news for northeastern Oklahoma City

Just this week, the Homeland grocery store chain announced that it will build a new 30,000-square-foot grocery store in northeast OKC.

Homeland CEO and President Marc Jones said in a press release, "Homeland has worked closely with and received tremendous support from our City Council members, the mayor, chamber and economic development organizations to develop a plan that will meet the needs of our friends and neighbors who live in northeast Oklahoma City." Homeland hopes for a completion date in late 2020 or early 2021. The release also noted the company plans to build a new 35,000-square-foot corporate headquarters next to the new store.

Toledo, Ohio: A hospital opens a grocery store

In 2010 staff at Promedica healthcare system in Toledo, Ohio, had begun to look more broadly at the social determinants of health among their patients and believed a full-service grocery store in the UpTown neighborhood could help spur better health. They approached local and national grocery chains and offered to be a partner by providing health education at the store. The chains politely declined. “It’s not our business model,” they said.

“That was a gut check,” said Kate Sommerfeld, who heads the Social Determinants of Health Institute at Promedica. The healthcare system realized it might need to do this on its own.

Large supermarket chains are often quick to pass on low-income neighborhoods because they presume (often falsely) that there’s little value or spending power there. Yet as research has shown, if the analysts just looked a little harder, they’d find ample spending power. A recent analysis of Mastercard credit card data (made anonymous) in a historically Black neighborhood in New Orleans found that following several community development projects, growth in consumer spending was 12 times greater than the city as a whole.

In Toledo, the national grocery chain may have declined, but Promedica’s CEO was determined to push ahead despite the odds, said Sommerfeld.

So a hospital went into the grocery business.

Today the 6,500-square-foot Market on Green, which is owned and operated by ProMedica, is part of a much larger $50 million community investment as part of the ProMedica Ebeid Neighborhood Promise for place-based investments.

The hospital has learned many lessons in operating a grocery store, among them to be humble and pivot when things aren’t working out.

The key to success is to engage many partners. “There’s strength in partnering with people who have been doing this.”

“It’s been a steep learning curve,” Sommerfeld said. “We build hospitals not grocery stores.”

The key, she said, is to engage many partners. The lightbulb has clicked on among hospitals that investing in neighborhoods is a good thing to do, but that doesn’t mean healthcare systems have to reinvent the wheel.

“Others have been doing this for decades,” Sommerfeld said. “There’s strength in partnering with people who have been doing this.”

The biggest lesson, though is that while food is important you need a holistic, intentional investment if you want to succeed. In this case, the project includes affordable housing, a financial coaching program, and a job training program.

Their efforts are paying off. A medical prescription from Promedica clinicians for free, healthy food for patients identified as at risk for food insecurity has led to a 15 percent reduction per person in healthcare costs. The grocery store’s impact will take longer, but said Sommerfeld, “we’re on the right path.”

Healthy Snacks Reach a Chicago Food Desert

CHICAGO -- A new and clean corner store in Chicago is taking on a food desert by stocking a variety of fresh foods and snacks in addition to the processed snacks common in the neighborhood.

The store, Louis Groceries, is almost has the white starkness of a hospital room, according to a WBEZ Radio report, but color from the food explodes on the shelves. It's stocked with fresh spinach, celery, mushrooms, limes and pears. And customers speak glowingly about the store's Amish chicken or share recipes inside, according to the report.

Louis Groceries serves residents in Chicago's Greater Grand Crossing neighborhood. In this immediate area, fresh-food options are limited, and Louis Groceries is a nonprofit store with the mission to get people to eat better.

Shopper Kevin Foston visits daily now, having discovered it on his way to the gas station in the next block that also sells food. The unhealthy kind.

"I hate to say this but yeah, I was going to buy some junk food. Don't print that. Just me saying that lets you know the real value of this place. Most of the people in this community--that's what we had to look forward to," Foston, a graphic designer, told the radio station.

Near the store's cash register is what staff call the "healthy row," with items like trail mix and salt-free or sugar-free snacks. Louis Groceries wants to improve what people in the neighborhood eat, so yes, there's fruit, nuts and apple chips, but they compete with processed junk food and rainbow-colored sugary drinks, too.

"Frito-Lay and Coca-Cola I would say are our top sellers," said Terri Zhu, the store program director/manager. "But people have been buying produce. I would say grapes and bananas." She said there's no disconnect between the healthy mission of offering fresh food and good meat alongside snack foods.

"The idea is for people to make a choice. So we're not going to take away your Frito-Lay from you," Zhu said.

Since Louis Groceries is non-profit, it can afford to experiment and make risky financial choices, like not selling much fresh food at first. The idea is to solve a problem that other food advocates encountered, according to the report.

They learned that plopping crisp vegetables and ripe fruit in communities doesn't mean customers will automatically purchase them if those items haven't been in their diets. So, Louis Groceries fills in the gap with education, to build demand for the healthy stuff over the long haul. Hence, it offers healthy cooking demonstrations and nutrition classes on site.

"A lot of activity around food deserts have been very supply focused, like we need to put supermarkets in these areas," Zhu said.

Zhu said the idea is to get people to eat healthier--not just give them access.

Nonprofit grocers are trending across the country. Portland, Ore., opened one a year and a half ago. One is scheduled to open this spring in suburban Philadelphia.


When I arrived at Findlay Market that April day, a sense of pre-shutdown life was still palpable. Customers were buying goetta at Eckerlin Meats and ham salad at Silverglades. Jean Robert de Cavel’s French Crust was doing takeout, and Dean’s Mediterranean Imports was packing orders for customers. I could have tricked myself into thinking we weren’t in the middle of a pandemic if it weren’t for the distances people were keeping from each other and the face masks that ranged from homemade to medical grade.

My destination for the spinach I craved was ETC Produce & Provisions, opened in 2019 by Toncia Chavez and her husband, Estevan. The couple sells fresh produce grown on their farm in Felicity, Ohio, as well as products from other Ohio Valley farms and artisans. I asked if Toncia was there and two seconds later she came bounding out of nowhere, exhibiting the smile and energy I normally associate with store owners at grand openings. “It’s been crazy here!” she told me. “I’ve never seen anything like it.”

While the number of customers was down at ETC, the amount they were buying was up. Way up. “People used to buy about six items now they’re buying around 30,” Chavez said. Her home deliveries had increased to the point where she’d hired 15 additional workers, most of them laid off from OTR restaurants, breweries and tattoo parlors. Sales of salad blends and other greens had more than doubled. She was selling around 200 pounds of onions per week.

It all made sense, Chavez told me. At a time when walking through the automatic doors of a big grocery store could elicit dread, a lot of folks were opting for safer, more intimate shopping experiences that harkened back to a simpler time.

That theory was reinforced when I walked into Madison’s grocery just across the street from ETC to pick up some chiles for a pozole I planned to make later in the week. The place was at capacity (only 10 people at a time) as shoppers made quick transactions for locally made breads, pastries and gelato. Customers were chatting about recipes and their own wellbeing with the staff, wishing they could just unmask themselves and hug one another.

“I think we’ve returned to an almost Main Street mentality when it comes to food shopping,” agreed Len Bleh, owner of the Downtown butcher shop Avril-Bleh & Son, whose sausages, steaks and hot dogs are featured at many Cincinnati restaurants. And while those accounts had nearly vanished, Bleh was seeing unprecedented retail sales, up around 50% more than usual for this time of year. “People are home, they have kids at home and they are eating at home,” Bleh told me.

But if Avril-Bleh and Findlay Market tricked me into thinking things were normal, the rest of OTR knocked any sense of normalcy right to its knees. Hardly a soul could be found on Vine Street, where once-bustling spots like The Eagle, Taste of Belgium and Holtman’s Donuts were shuttered. And while chef Dan Wright was among the first to open on this section of Vine, his three restaurants (Pontiac, Abigail Street and Senate) were closed even for takeout, which made me worry that none of them were ever coming back. And those closures have taken their toll on some of the city’s most beloved artisans.

Later that day, Matt Madison, owner of Madisono’s Gelato, told me business was down substantially. Like Bleh, a big part of his sales were to local restaurants and coffee shops. Unlike Bleh, his product is more a luxury than a need. Restaurant customers had stopped placing orders. “I knew we’d have fewer calls, but we didn’t expect zero,” he said. Still, retail sales of his gelato—sold at independent grocery stores, as well as Kroger and Whole Foods—were up 10% over last year, he told me. A good sign of customer loyalty, but not nearly enough to make up for his wholesale losses. Madison was also wondering what Ohio’s appetite for premium ice creams and gelatos would be once the quarantine was over.

Just when it seemed local food was gaining momentum, everything suddenly changed. “We were just starting to feel real traction,” said Andrea Siefring-Robbins, who, along with her husband, Scott Robbins, owns Urban Stead in Evanston. The two-year-old company’s cheddars, goudas and other cheeses are made on premises in a large tasting room and are served at Cincinnati’s most popular restaurants. “Wholesale was big for us,” Siefring-Robbins said, adding that they were just starting to sell their cheeses to restaurants outside the Ohio Valley in Cleveland, Nashville and beyond.

After losing their wholesale business, closing the tasting room and laying off their entire staff, the couple had come up with a plan to keep their company on life support. The first step was altering their business model from wholesale to curbside retail. Working with local producers such as Urbana Coffee, Indian Creek Creamery, Hungry Noodle, Allez Bakery and TS Farms in New Vienna, Ohio, they started selling produce, meats and pantry staples to neighborhood residents. “In Evanston, we are in a food desert,” Siefring- Robbins said. “I’ve always wanted to offer a greater variety of products, and this has been an opportunity to see what people want and to see what our ability is to get it to them.

And I’ve tried not to do significant markups, usually just a dollar. I knew people would support us initially but I knew our staying power would be longer if we had a bigger variety of products.”

Scott Robbins told me it’ll take a year and a half to two years to get back to where they were before COVID-19. “Are you going to make it?” I asked.

“Oh, yeah. We’re going to make it,” he said. “We’ll definitely make it.”

Oasis for ‘food desert’ proposed on St. Paul’s East Side

Correction: A previous version of this story included a U.S. Department of Agriculture map of “food deserts” was published in 2009, before the construction of Cub Foods on Clarence Street and the Hmong Village on Phalen Boulevard, so the percentages of East Side residents without easy access to fresh produce may be lower today in nearby census tracks.

St. Paul’s East Side is abundant in many things, but fresh fruits and vegetables are not among them.

A dearth of grocers has residents turning to gas marts and convenience stores for produce that often is more expensive. The lack of easy access to reasonably priced healthy food is thought to be a contributor to obesity and other health concerns among the area’s growing immigrant population.

Now, a doctor, a health care marketing representative and two St. Paul moms are trying to drum up support for a solution: a possible new member-owned grocery store.

Since October, their “Gateway Food Initiative” has been meeting with urban farmers, grocers and neighborhood groups to gauge interest in opening a new food co-op somewhere on the East Side.

“There was really strong support from the word go,” said Stephanie Harr, the marketing representative. Still, it’s no small or certain endeavor. So far, they’ve raised about $3,000, which means they likely have hundreds of thousands of dollars left to go.

Eager to increase interest and recruit paying members, the initiative has scheduled a kick-off party for Thursday, April 26 at the Water and Oil Art Gallery on East Kenny Road.

Harr and other initiative members point out that the city’s largest collection of neighborhoods maintains one of the highest concentrations of immigrants and children.

The lack of groceries offering fresh produce hasn’t escaped the notice of federal officials, who have designated large swathes of the East Side as official “food deserts” – low-income areas with a high concentration of people who live far from a grocery.

In some East Side areas, a 2009 federal Department of Agriculture map places 50 or 60 percent of residents in that category.

For possible models, the initiative is looking at customer-owned grocers such as Mississippi Market on West Seventh Street, the Hampden Park Co-op on Raymond Avenue and the Wedge in Uptown, Minneapolis. The stores are operated by a manager or management group but owned by the public, which is invited to buy shares, stock or membership in the market.

Each year, members receive dividends based on the company’s profits. The checks tend to amount to a few dollars per share, if that, but proponents say they give residents a sense they’ve invested in their own community. The markets are open to anyone, members and nonmembers alike.

“Our vision is broad,” Harr said. “It includes organic food, it includes local food, it includes fresh food.”

Kari Neathery, general manager of the 40-year-old Hampden Park Co-Op, said she’s spoken with the Gateway Food Initiative about their plans. She noted the cost of organic food “is fairly significant,” making it all the more important to draw a range of income groups into the customer base.

So far, Gateway Food Initiative members have established a steering committee and raised $3,000 toward their goal. They have a lot of work yet to do.

Committee member Sarah Geving of the Payne-Phalen neighborhood said they’re currently selling lifetime memberships for $90, with the goal of having between 1,000 and 2,000 members by the time the store opens.

Before any site opens, however, they have to conduct a feasibility study and hire a general manager. There’s also the question of finding the right site. In North Minneapolis, the Wirth Co-op is going through a similar scouting process.

“There are several co-ops in the Twin Cities that are very solid,” Geving said.

One issue is weighing social justice efforts that benefit the poor against market realities.

Many co-ops have thrived by catering to clientele willing – and able – to pay higher prices for organic avocados or gluten-free muffins and “Fair Trade” items. Finding the right price point for middle- and low-income customers could be a challenge. If the private sector hasn’t found a sustainable market for healthy food on the East Side, will a loose coalition of green thumbs and neighborhood activists?

Those and other questions will have to be addressed in the feasibility market study, and the results likely will be telling.

So failure is a possibility. If the store does not open, co-op backers will try to return as much money as they can to members.

Beth Butterfield, a Payne-Phalen resident, said the group hopes to market their food co-op beyond the East Side to commuters driving through from Woodbury, Maplewood, White Bear Lake and other suburbs.

They also are hoping some of their strongest constituents will come from among the many Southeast Asians and other immigrants and ethnic minorities who have found a home on the East Side.

Dr. Stefan Pomrenke works closely with Hmong residents from the McDonough Homes, a public housing complex, and keeps an office in a nearby community center. He recalls interviewing an older Hmong patient with high cholesterol who told him that in America, he eats meat twice a day. In Laos, the man ate meat twice a year. That and other changes to what had been a heavily agrarian diet were weighing heavily on the man’s health.

“I come at this from a food justice or social justice perspective,” said Pomrenke, who lives in Dayton’s Bluff.

“How can you engage the ethnic communities? I see, as a family physician, a lot of the groups that are coming here and adopting American behaviors. Ninety percent of my patients are Hmong, so I see the food impact on everyday people.”

Around the corner from his house, Pomrenke said, a small market sells nonperishable goods, but its fruit and vegetable selection is extremely limited. Prices also appear to have a high markup. A wider selection is available at the Hmong Village, an indoor shopping bazaar between Phalen Boulevard and Johnson Parkway, but it’s tougher to access for low-income residents who might not have cars.


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