When it Comes to Healthy Food Access, Are”Food Deserts” and Food Swamps” Really that Different?

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Originally published in The DASH-NY Newsletter September 2012

by Perrin Braun

The relationship between obesity and access to healthy foods has been complicated by recent studies that suggested food deserts are not an issue. The term “food desert” has been used by the media, economists, and policy-makers to describe communities that have limited access to healthy food outlets. The communities plagued by food deserts are often of color and typically low income. Many policy decisions and interventions—including Michelle Obama’s Let’s Move! campaign—have operated under the premise that addressing food deserts can help curb obesity in these communities. Enhancing the availability of healthy foods is now a national priority, but are we missing the mark if we are not simultaneously addressing the overabundance of unhealthy food in many of these communities?

The USDA currently defines a “food desert” as a “low-income census tract where a substantial number or share of residents has low access to a supermarket or large grocery store.” One of the initial proposals to address the problem of food deserts was to add more food retail options to these neighborhoods. However, simply increasing the number of grocery stores in under-served communities is not a universal solution to decreasing the prevalence of hunger and chronic disease.

John Weidman, the Deputy Executive Director of Food Trust, argued in a recent New York Timesarticle that “not all grocery stores are equal,” meaning that every supermarket doesn’t necessarily stock fresh, affordable, and appealing produce. In fact, a 2006 study in the American Journal of Preventative Medicine found that the quality of the grocery stores in low-income neighborhoods may influence the BMI of residents. These studies give increasing credence to the idea that issues related to access need to be considered in conjunction with quality, pervasiveness of competing foods, and affordability as barriers to creating healthy eating behaviors.

In fact, current research has suggested that although some areas designated as food deserts may contain some healthy food options, they are so flooded with energy-dense, low-cost options that it undermines efforts to make healthy choices. Donald Rose and his colleagues were the first to name this concept “food swamps” in their 2009 study, Deserts in New Orleans? Illustrations of Urban Food Access and Implications for Policy. Several researchers propose that the focus on the food environment in these communities needs to be shifted from what they lack to draining the food swamps of what they have in abundance—namely, high-calorie foods that fuel obesity.

Does the “food swamp” vs. “food desert” debate address the complex economic and health needs of low-income neighborhoods? There is a substantial body of evidence demonstrating the existence of food deserts. At the same time, the latest observation is that low-income neighborhoods contain an overabundance of fast food establishments. So, it appears that food swamps and food deserts are not necessarily mutually exclusive. For example, one can live in a county with no grocery stores for miles around, butplenty of fast food or quick service establishments nearby.

Therefore, it is important to consider both ease of access and lack of access when considering the main drivers of food choice in underserved neighborhoods. A 2009 USDA report notes that access to a supermarket or large grocery store is a problem for only a small percentage of U.S. households. It shows that while 23.5 million people live in areas more than one mile from a supermarket or large grocery store, only 11.5 million of them (or 4.1 percent of the U.S. population) are actually low-income. It has also been argued that you would be hard-pressed to find an urban community that has absolutely no access to fruits and vegetables, but what matters most is how much fresh produce costs in relation to energy-dense fast food options.

Food advertising is also a part of the problem, but determining its true impact will require further assessment. A 2010 study from the Rudd Center demonstrated that fast food marketers have been targeting children across a variety of media and in select restaurants that provide mostly unhealthy side dishes and drinks with kids’ meals. It also noted that children as young as two are viewing more advertisements for fast food than ever before.

So, what does this mean for the “food swamp” vs. “food desert” debate? Increasing access to healthy foods is part of the solution, but it is not a panacea. While it’s necessary to make affordable, nutritious, and appealing food options more readily available, it’s also important to work towards decreasing the prevalence of unhealthy foods. The healthy choice needs to be the easiest choice!

Calorie Labeling

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Originally published in The DASH-NY Newsletter January 2013

by Shara Siegel

New York City pioneered calorie labeling in 2008, with Albany following close after in 2009. These efforts served as a model for the national legislation mandated by the Affordable Care Act. The ACA requires that calorie labels be added to standard items on menus and menu boards of chain restaurants with 20 or more locations doing business under the same name, which would include places like Starbucks, McDonalds, and Cosi, to name a few examples. According to the law, if you want to know specific nutritional information about a brownie, burger, or strawberry banana smoothie at any of these venues, they will have to disclose this in written form upon request. Requests could include anything from total calories and calories from fat to the amounts of fat and saturated fat, cholesterol, sodium, total and complex carbohydrates, sugars, dietary fiber, and protein.

Calorie labeling is intended to help Americans make healthier nutritional choices when presented with information about their choice at the point of consumption. With more people purchasing food outside their homes and the rates of obesity continuing to grow, this intervention is timely and can potentially affect millions of people. A recent NYS DOH effort, “ichoose600,” built upon this idea, encouraging mothers in particular to aim for a target of 600 calories or less when buying meals at fast food restaurants. The campaign saw great results with increased recognition and use of posted calorie labels in chain restaurants in four counties in New York State.

Now, with the ACA, vending machines will also be subject to some regulations designed to make consumers more conscious about their food choices. Vending machines offer easy, convenient, and quick access to food, but they are not typically stocked with the most nutritious items. The ACA requires vending machine operators who own or operate 20 or more vending machines to disclose calorie content for items that are being sold. Reaching for that 3 p.m. candy bar? The new regulations might cause you to think twice! Check the Food and Drug Administration website for more information on the topic, and theFederal Register notice for more details on the requirements.

Community Benefit

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Originally published in The DASH-NY Newsletter January 2013

by Shara Siegel

The Affordable Care Act promotes broad-based community prevention initiatives through changes to the nonprofit hospital community benefit program. The legislated changes to the tax code are premised on the idea that with more Americans receiving health coverage, nonprofit hospitals will provide less uncompensated coverage, or charity care, over time. The provision of charity or uncompensated care was initially the primary means by which nonprofit hospitals could qualify for federal tax-exempt status. Since 1969, or after Medicaid and Medicare drastically reduced the number of uninsured, the IRS has broadened the scope of qualifying activities beyond charity care to include programs that improve the health of the community, public health initiatives, and health promotion.

Some of the ways hospitals have fulfilled these obligations include providing education for health professionals, conducting community health screenings, supporting school-based health initiatives, and undertaking other outreach programs that do not just treat illness, but promote wellness.  The recent community benefit changes in the ACA encourage more hospitals to engage in this kind of work, and pave the way for innovative new community partnerships and community-based interventions.

Effective for tax years beginning after March 23, 2012, hospitals are to collaborate with local stakeholders to develop a Community Health Needs Assessment (CHNA). The assessments are to be conducted every three years, and in between, hospitals must implement strategies to address the identified needs.

Stakeholders across New York have been developing the State Health Improvement Plan: The Prevention Agenda 2013-2017  to help inform hospitals and their community partners about community interventions that have been proven to prevent disease at a population level. The Prevention Agenda (still being finalized) includes a special section on obesity prevention that recommends interventions like defining/innovating business models that support increased use of healthy, locally grown/developed/ minimally processed foods and requiring health insurance contracts to cover obesity and diabetes prevention programs. This will be an important resource both for hospitals developing their community health needs assessments, and for local health departments identifying local priorities. In fact, the Prevention Agenda calls on local health departments and hospitals to identify two or three of the ten Prevention Agenda priorities and to work with community providers, insurers, community based organizations and others to address them. Statewide program and policy initiatives will complement local efforts.

Through the framework of the Prevention Agenda, New York will see new and stronger partnerships between hospitals, local health departments and other community organizations.  When operating in alignment, these entities can best support the health of their entire community.

Community Transformation Grants

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Originally published in The DASH-NY Newsletter January 2013

By Shara Siegel, with contributions from Jennifer Richey, Communications Director at the Partnership for a Healthier New York, Shaquana P. Divers, Program Manager, H.E.A.R.T., and Amy Jesaitis, Physical Activity and Nutrition Coordinator for the Healthy Heart Program at the New York State Department of Health.

New York is the lucky recipient of three multi-million dollar Community Transformation Grants funded through the Prevention and Public Health Fund that was created by the Affordable Care Act. The CTGprogram promotes wellness and addresses the root cause of diseases. New York communities are using these funds to create innovative partnerships with untraditional partners to improve the health of their communities in the priority areas of tobacco-free living, active living and healthy eating, and quality services to prevent and control high blood pressure and high cholesterol.

The Centers for Disease Control and Prevention has committed $900 million to funding CTGs over the first five years. Approximately $103 million in prevention funding was awarded in 2011 to 61 states and communities, and in 2012, another $70 million went to 40 communities with fewer than 500,000 people. By focusing on where people live, work, learn, and play, the CTG program is expected to improve the health of more than four out of 10 U.S. citizens—about 130 million Americans. The University of Rochester and NYC Department of Health and Mental Hygiene received Implementation Awards for New York in 2011, and the New York State Department of Health/Health Research Inc. received a Small Communities Award in 2012.  Learn more about the innovative partnerships underway in Rochester, New York City, and Broome-Cattaraugus and how they are impacting their communities below.

The CTG recipient in Rochester is a coalition led by the University of Rochester Medical Center and the Monroe County Department of Public Health. They were awarded a five-year grant to develop HEART (Health Engagement and Action for Rochester’s Transformation), “a comprehensive initiative to improve the health of Monroe County residents by creating a community environment that supports healthy behaviors, thus preventing chronic disease and reducing health care costs.”

One interesting HEART initiative is a partnership with its local food bank, Foodlink. CTG funding helped to staff and support 10 urban farm stands that distributed over 21,000 pounds of produce in the city of Rochester this past summer. One of the farm stands was at the Rochester Recreation Club for the Deaf, which increased access to healthy foods for the deaf community. HEART also supported the purchase of equipment that will be used to maintain the shelf life of produce during the winter months. In addition, HEART will support Foodlink’s Healthy Corner Store Initiative.

HEART also funded a community-wide Crime Prevention through Environmental Design (CPTED) Training. Twenty-one residents, police officers, and recreational staff were trained on the principles of crime prevention. These principles are being incorporated into neighborhood improvement plans to address safety concerns that hamper physical activity in our communities.

In 2013, HEART plans to continue its work in active transportation and workplace wellness, and its Virtual Clinician tool that teaches about high cholesterol will be available for clinical settings.

New York City’s CTG established The Partnership for a Healthier New York City.  Throughout the first year of the CTG, the Partnership began to formally link community groups through coalitions based in each borough, to ultimately form a citywide partnership. Some of the lead agencies for the work are longtime supporters of healthy communities, but are not necessarily traditional health organizations. For example,Bedford Stuyvesant Restoration Corporation, best known for its community and economic development work in that area, is the lead partner in Brooklyn. Make the Road New York, a leading advocate for immigrants, is the lead agency in Queens.

During the first year, the lead agencies promoted healthy activities occurring in their communities, worked on op-eds, and conducted relevant trainings. For instance, the Manhattan borough lead, Mt. Sinai, hosted an active design workshop to “Re-envision Our Neighborhoods” and presented to Community Board 7 on active living. This year the Partnership is working to improve access to healthier food and beverage choices, reduce underage and excessive drinking, and decrease exposure to secondhand smoke in homes and public places.

For more information and ways to get involved, please contact the Partnership at info@healthiernyc.org.

The New York State Department of Health/Health Research Inc. was recently awarded a grant to address National Prevention Strategy priorities of tobacco-free living, healthy eating and living, and healthy and safe physical environments for children ages 0-18 in eight small communities in Broome, Cattaraugus, and Chautauqua Counties. The eight communities, which are defined according to school district boundaries, were selected based on high socioeconomic need and risk, high rates of obesity among school-age children, and capacity to implement grant objectives.

The communities will conduct activities in a variety of sectors that contribute to the overall goals of the CTG program. There are a number of initiatives aimed at increasing physical activity and making healthier food choices available. For example, there will be more childcare centers and day care homes that provide developmentally appropriate physical activity for young children.  Awardees will adopt or make improvements to policies and practices encouraging students to walk or bike to school and develop Complete Street strategies. They will also develop regional food procurement initiatives to secure more competitive pricing and improve the nutritional quality of the school lunch program. Buildings, such as schools, organizations, and municipal buildings, will decrease availability of sugary drinks that they sell or serve. Finally, beyond these advances in physical activity and nutrition, all local housing authorities will work on implementing smoke-free policies for their multi-unit properties.

These three examples, in Rochester, New York City, and Broome-Cattaraugus, offer great insight into the community-based chronic disease prevention opportunities offered through the CTG grants and are reflective of the types of developments in health promotion occurring across the country as a result of these grants.

Hip-Hop Artist Promotes Health App

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By Lonnie Portis

Celebrity endorsements are nothing new in America. But it is new that music artists are taking on full-time jobs at companies as creative directors! Instead of the typical beverage, food or mobile phone company, hip-hop artist, Lupe Fiasco, is creative director of the new health and wellness app “higi” (rhymes with Ziggy). Lupe Fiasco tells Billboard, “The dope part about this, other than just being creative director, is adding value to this company because it adds value to the world”. Since his father passed away at the age of 54 from diabetes, higi’s purpose resonates with the rapper. Innovation is essential to obesity prevention and Higi certainly takes a cool, technological approach to holistic wellness.

Higi was created as a tool to curb obesity rates. The developers have realized that many people find being healthy a difficult task, probably because of adaptation to unhealthier lifestyles. There is no pill or vaccine to cure or prevent obesity but a change in lifestyle and adopting healthier habits is the best way to change a negative health prognosis. Higi notes the largest obstacle to a healthier lifestyle is being informed:

Gaining access to the right information, understanding it and acting on it is more difficult than it should be. But why should it be? Everyone wants to look, live and feel better. What does that mean and more importantly, how do we get there? These are the questions we at higi have set out to answer.

Higi mixes access to information; community support, technology and health metrics to promote healthier lifestyle choices. They combine and analyze information about your body (BMI, weight, blood pressure, etc.), community (support, encouragement and interactions with others) and lifestyle (physical activity, sleep, etc.) to create an individualized score that ranges from 1 to 999. It is health, social networking and technology all wrapped into one. Lupe Fiasco has decided to let higi take priority over his music career but still plans to work on his music. It is always great to see where creative minds meet innovative solutions, especially when it relates to health and obesity.