Systems

I commented on a bulletin board recently about an article talking about improving health by saying that even though we have systemic problems with achieving healthy living, most of the time we are only offered individual solutions. This article is a nice example of people finally looking for systemic solutions too.

In Cities, Healthful Living Through Fresher Shopping

By Amy Goldstein
Washington Post Staff Writer
Sunday, October 15, 2006

PHILADELPHIA -- When Larry Lawrence drops into ShopRite, he steers his shopping cart to the towering mounds of produce. "It is like I am being drawn," he said, "by the peaches and the plums and the bananas."

Lawrence, 57, has been eating more fruits and vegetables, and fresh fish, too, since the sprawling store opened five blocks from his house in Eastwick, an industrial swath of southwest Philadelphia that was chosen in the 1950s as the nation's largest urban renewal project. Now, Eastwick is one of the first sites of a new strategy for social change: a government campaign to bring supermarkets stocked with healthful food into neglected inner-city neighborhoods to improve public health.

The Pennsylvania Fresh Food Financing Initiative, leveraging $30 million in state money with $90 million in private funds, is the most ambitious of a spate of state and local projects around the country. They represent a different model for public nutrition programs, which have relied since the 1960s on federal subsidies, such as food stamps and WIC.

Healthful food is scarce in many inner-city neighborhoods, where much of the food comes from corner markets and greasy takeout places. Instead of subsidizing shoppers, the projects shift the emphasis to the private sector, offering coaching and financial inducements for grocers to go into areas they shunned for decades.

These initiatives grow out of new research exploring the relationship among proximity to fresh food, the nation's obesity epidemic and diseases such as diabetes that are affected by diet. "We tried to make the connection between grocery stores and public health," said R. Duane Perry, executive director of the Food Trust, a nonprofit group that, in a pioneering 2002 study, produced maps showing that low-income neighborhoods of Philadelphia with few or no supermarkets had high death rates from diet-related diseases.

A study in Chicago, released three months ago, measured the distance from every city block to the nearest grocery store and fast-food restaurant. It found that people in what it called Chicago's "food deserts" died early in greater numbers and had more diabetes, obesity and high blood pressure.

Such public health discoveries -- combined with an older view of supermarkets as tools of economic development -- have been spurring new policies around the country.

In the District, a mayor's commission on nutrition in July issued a study by a nonprofit group, D.C. Hunger Solutions, showing that obesity is highest in the city's two wards east of the Anacostia River, where poverty is greatest and access to grocery stores is worst. The D.C. government has worked to attract a Giant supermarket that opened last year in Columbia Heights and one being built in Congress Heights, but those efforts began years ago more out of a desire to revitalize the neighborhoods than to improve residents' eating habits.

Baltimore created a Supermarket Initiative in 2002 that has used city economic development funds to attract 19 stores so far. The California legislature passed a bill in August designed to give low-income residents discounts to buy fruits and vegetables -- and help mom-and-pop stores carry more fresh food.

Chicago's planning department held a "grocers' expo" in February for executives from supermarket chains across the Midwest, who were handed a book touting 50 spots in Chicago where stores are needed, plus financial incentives the city could offer. And the National Conference of State Legislators just brought lawmakers to Philadelphia from Louisiana, New Mexico and Michigan to learn how they might replicate the food-financing initiative.

Here in Philadelphia, the initiative's first two years have yielded a central lesson: Despite the fervor of politicians, civic groups, bankers and several grocers, creating successful supermarkets in poor city neighborhoods is hard. It is daunting to train workers, maintain security -- even to acquire enough land.

"The money, to be honest with you, was the easy part," said state Rep. Dwight Evans (D), the initiative's main political patron. "The toughest part is to make this work."

The Rev. Leon Sullivan, the renowned civil rights leader, developed Progress Plaza in North Philadelphia nearly 40 years ago as an example of black empowerment. For its first three decades, the shopping center was anchored by a series of grocery stores. The last one closed eight years ago, and now the only food available is Popeyes fried chicken. Nearby drugstores have added shelves of canned food and chips, but not produce.

Helen Love, 86, a widow and retired inspector for an electronics plant, is one of many original residents in the nearby townhouses of Yorktown, the model neighborhood for black residents that went up in the 1960s. Now, she and a friend, Marvella Lattimore, take turns every other week driving each other to a supermarket half an hour away. Love parks in a handicapped spot and is so tired when she gets home that, she said, "that's usually it for the day."

Across the street, Israel Edward, 74, who has stopped driving because of poor eyesight, takes the bus to Reading Terminal Market in Center City. "I only bring what my two arms can carry," he said. Next door, Doris Turner, 85, gets to a large grocery store about every two months, when a grandson in the National Guard can take her.

Evans, the legislator, lived near Yorktown as a young boy and remembers shopping at Best Market with his aunt Rosie. He remembers the race riots of 1964 along the street the supermarket was on, with nickels all over the ground from parking meters the looters had broken. And he remembers, in the few years after the violence, the disinvestment by white merchants.

So when the Food Trust's director brought him the maps of grocery stores and death rates, he understood their importance. As minority chairman of the Pennsylvania House Appropriations Committee, he has put $10 million in the state budget for the food initiative each of the past three years, requiring three times as much in private financing. The Food Trust helps with applications. The Reinvestment Fund, a nonprofit financing institution, has secured money from banks, screens applicants and awards the grants. The money can be used for marketing studies, land acquisition, environmental cleanup, city permits, construction, and help with worker training and store security.

So far, the fund has given grants for nine stores in Philadelphia and five elsewhere in the state. Most are for large, new supermarkets, but a few are helping corner stores expand or buy refrigeration equipment to carry more fresh food.

Not all succeed. A Shop 'N Bag opened in West Philadelphia in late 2004 and closed a year later -- a casualty of an inexperienced owner and delays in housing redevelopment that was to have generated customers, according to Evans and the Food Trust's Perry. And there have been snags. Fresh Grocer, which is to return a supermarket, at last, to Progress Plaza, was to have its opening this fall, but that will be delayed at least until late in 2007 -- the result of complications with permits and with renovations of the rest of the shopping center.

In an industry with typical profit margins of 1 to 2 percent, inner-city neighborhoods are "a far more complicated place to build your business," with higher costs and less demand for profitable luxury foods, said Jeffrey Brown, president of Brown's Super Stores, which owns the ShopRite in Eastwick. The store, near the Philadelphia airport, opened two years ago with help from a $5 million tax refund for capital investment and a $250,000 grant to train workers.

Brown's strategy here has been to align the business more closely with the neighbors than he does at his suburban stores. Before opening, he invited civic and religious leaders to lunch to talk over what they expected from the store. Working from scratch, his employees make sweet-potato pies and cakes, down-home potato salad, seafood cakes, and 100 other recipes catering to local tastes that he could not buy wholesale.

Brown conferred with the imams at local mosques about what foods meet Muslim residents' halal requirements. He has brought in a Western Union outlet for the neighborhood's Caribbean immigrants to wire remittances.

A community job bank has funneled 90 percent of the store's workers, many from families where steady jobs are unfamiliar, Brown said. He invited Maggie Powell, longtime president of the Eastwick Project Area Committee, to help teach new hires how to comport themselves at work. And when Powell's 39-year-old son was fatally shot in June, store managers took food trays to her house at no charge for three days.

In turn, Powell and local politicians helped to lobby the local utility company, Peco, after Brown was told the power could not be turned on in time for the store's grand opening. It was. Other problems prove harder to solve. When a manager catches a shoplifter, Brown said, the police say they are too busy with violent crime to come.

The store lost money in its first year, Brown said, but had a profit of close to 1 percent in its second.

The effect ShopRite and the other stores are having on nutrition is less well understood. Recent research, for example, that included rural, suburban and urban areas of a few states showed that black residents -- but not white ones -- had somewhat more healthful diets if they could buy fresh food nearby. A few months ago, Stephen Matthews, a sociologist at Pennsylvania State University, began a rigorous study in Philadelphia on whether the arrival of a supermarket changes the amount of fruits and vegetables people eat.

On a recent afternoon, Larry Lawrence, stopping in on his way home from work as a counselor for troubled boys, said: "I'm glad they moved in. There are two or three guys, all day long, putting out fresh stuff. Bananas. Strawberries."

Not all shoppers are attracted by the produce. "It's the sweet-potato cake. They don't have that at any other store," said Toinette Alexander.

Still, Brown, said, "we are doing $40,000, $50,000, $60,000 a week in fruits and vegetables. That is more fruits and vegetables than was happening before."