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American Indian Healthy Eating

Healthy Retail & Dining Initiatives

Encouraging Food Retailers to Facilitate Healthy, Native North Carolinians!

Your tribe just participated in one of the most rigorous food assessments for an American Indian setting to date!  But why is understanding access to grocery stores important?  While grocery shopping is perceived by some as a minor inconvenience, for many urban and rural settings accessing healthy, affordable foods is becoming a major obstacle.  Explore lessons learned about your tribe’s access through the American Indian Healthy Eating Project and visit the US Department of Agriculture Food Environment Atlas.

What is a Food Desert?

A number of definitions exist but generally a food desert describes a community who has limited access to healthy, affordable food.  Over the last ten years, research illustrates communities in areas with limited access to grocery stores eat less fresh fruits and vegetables and tend to have higher risk for type 2 diabetes, cardiovascular disease, and obesity.  Government, non-for-profit, academic, and community advocacy groups have also contributed to identifying grocery gaps throughout the US.  In addition, the media has helped increase awareness about food access struggles for rural and urban areas, including highlighting the increased number of store closures during this economic down period.  The First Lady Michelle Obama through her Let’s Move! campaign has also increased awareness of opportunities and obstacles for making all communities, healthy communities.  To check out your community’s access, explore the maps created by direct observation posted on http://americanindianhealthyeating.unc.edu, go to US Department of Agriculture Food Environment Atlas or Food Desert Locator, and review Feeding America’s Map the Meal Gap.

Strategies to Open and Sustain Food Retailers in Under-Served Areas

Local, state, tribal, and federal government initiatives have tried to expand the availability of grocery stores in under-served areas, many using healthy food financing initiatives to provide loans and other financial support to help grocery stores overcome the initial costs of opening a grocery store.  The Food Trust has partnered with most of these governments to implement healthy food financing initiatives and is exploring similar approaches in Colorado, Massachusetts, Maryland, Mississippi, Georgia, Tennessee, Texas, Arizona, and Minnesota.  Grocery store case studies are featured in Harnessing the Power of Supermarkets to Help Reverse Childhood Obesity and Healthy Food, Healthy Communities.  The Centers for Disease Control and Prevention have also recently put together a report providing an overview of state initiatives to support healthy food retail.

Selected Local
Chicago, IL Mayor Rahm Emanuel aims to implement new policies, incentives, and permit processes for addressing food deserts in Chicago, through urban agriculture, grocery markets, and food trucks.  He has met with CEOs of area grocery stores during a “Food Desert Summit.”  He has proposed ordiances to expand the size of community gardens to promote urban agriculture and improved regulations to enable urban farms to sell their products at area farmers’ markets.  Along with the City Health Department, he proposed Healthy Chicago, which is a comprehensive plan to improve health throughout the city, across a variety of outcomes, including improved access to healthy, affordable foods.  The square footage of grocery store aisles in the city’s most underserved areas has been increasing over the last few years but there are still many areas underserved by healthy food, affordable retail. On October 25th, 2011, Mayor Emanuel invites the First Lady Michelle Obama to Chicago to kick off a Chicago Food Summit.  Chicago was recently awarded healthy food financing funding to improve access to healthy retailers in underserved areas.
Columbia, MO A City Council member is working with Unite 4 Healthy Neighborhoods to create a food policy council for the city to work on food access issues, particularly for the elderly and people without cars.
Austin and Houston, TX Austin established bus routes from at-risk areas to supermarkets and enacted legislation to support the renovation of a local grocery store.  Houston provided tax incentives to supermarkets to open in or near underserved areas.
Detroit, MI Mayor announced the Green Grocer Project to improve the quality of grocery stores and strengthen neighborhoods.
Nashville, TN Through a grant initiative, twenty-nine stores will be getting healthy corner store makeovers to improve fresh produce offerings.  The state of Tennessee integrates community gardens into their approach to increase access and awareness of obesity prevention.
New Brunswick, NJ Developing the New Brunswick Wellness Plaza, featuring one of the first supermarkets built in the city in decades.  The New Jersey Economic Development Authority received funding from the Robert Wood Johnson Foundation and potentially through the state legislature to create the state of New Jersey’s Food Access Initiative.  This may add $10 million in loans and $2 million from the RWJF grant.  The bill passed the full Senate as of January 2012 and was passed to the Assembly Budget Committee.  Newark has also been funded to build fresh food retailers in underserved communities.  The Robert Wood Johnson Foundation has committed more than $12 million to support access to healthy foods in underserved NJ communities.
New Orleans, LA The Fresh Food Retailer Initiative is investing $14 million in low-interest loans, from federal block grants and private donations, to build grocery stores and supermarkets in under-served areas.  A Central City grocery store is one of the first to receive a loan through the local initiative.  The program is using $7 million in Community Development Block Grant money from the city and $7 million from the Hope Enterprise Corporation, which is a community development financial institution based in Jackson, Mississippi.  The Food Trust, a Robert Wood Johnson Foundation grantee based in Philadelphia, is administering the program with another local group.
New York, NY Created the FRESH Initiative, which includes tax incentives and zoning enhancements to supermarkets investing in under-served communities.
Oakland, CA Built the Mandela Co-Op to help bring under-served communities fresh produce while employing area workers and farmers.
Selected State
District of Columbia Opened a Giant in 2008 in the distressed Anacostia neighborhood.  A number of other urban stores are being built and designed to promote walkers and bikers to feasibly shop at the stores.  DC Central Kitchen is also teaming up with DC Hunger Solutions and the DC Department of Small and Local Business Development to launch a program to deliver fresh fruits and vegetables to approximately 30 stores in Wards 5, 7, and 8.  DC Central Kitchen’s latest program is Healthy Corners, aimed at getting fresh produce and refrigeration units into stores in underserved areas of the city. In addition, the Arcadia Center for Sustainable Food and Agriculture will be launching a Mobile Market.  Using a decommissioned school bus retrofitted as a farmers’ market on wheels, this mobile market will accept Supplemental Nutrition Assistance Program (SNAP) benefits and offer Farm-to-School programs to local DC schools.
Illinois General Assembly approved $10 million in funding for the Illinois Fresh Food Fund, which aims to stimulate supermarket development in under-served areas of the state.
Mississippi Considering legislation to create a committee to study the availability of healthy food within the state.
Nebraska Considering legislation to provide state financing to organizations that provide healthy food in low-income communities.  The state fund and tax credits could be used by grocery stores, farmers’ markets, community gardens, and other food retailers that expand access to nutritious foods.  The bill was reintroduced after the Governor vetoed the bill in 2011.
New York Created a $10 million Healthy Food/Healthy Communities Initiative providing grants and loans to supermarkets to invest in under-served communities throughout the state.  Allocated specific grant resources to New York City to hire a coordinator to provide market research to attract supermarkets to build in the city and to assist supermarkets in understanding the permitting and approval processes.
Pennsylvania Created Fresh Food Financing in 2003 to support the building of 10 new stores in under-served rural and urban communities.  Now, the program has invested over $30 million in over 83 projects, providing more than 400,000 Pennsylvanians with healthier food choices in their communities, as well as establishing or sustaining 5,000 jobs and 1.6 million square feet of food retail space.
Federal
President Obama proposed the Healthy Food Financing Initiative in February 2010 to be a part of his 2011 budget.  The initiative linked the US Department of Treasury, US Department of Agriculture, and the US Department of Health and Human Services on efforts to equip grocery stores, small retailers, corner stores, and farmers markets in under-served areas to sell healthy foods.  This Tri-Agency effort would use a blend of federal tax credits, below market-rate loans, loan guarantees and grants to build private-public partnerships.  Until funds were appropriated, the three Agencies were also exploring ways within existing programs to eliminate food deserts.  In May, the program began to accept applications.
Through the American Recovery and Reinvestment Act of 2009, $25 billion in tax-exempt Recovery Zone bonds allowed state and local governments to obtain lower borrowing costs to finance economic development.  As one example, this federal tax-exempt funding enabled the opening of Stop & Shop supermarket in New York City.
Through the 2008 Farm Bill, the US Department of Agriculture’s National Institute for Food and Agriculture granted $900,000 to the Healthy Urban Food Enterprise Development (HUFED) Center at the Wallace Center at Winrock International.   HUFED provides grants and technical assistance to entrepreneurs and communities aiming to bring healthy foods to under-served communities.
The National Healthy Food Financing Initiative was introduced in 111th Congress in both the Senate (S3986) and the House (HR 6462) with bipartisan support.  Through loans and grants, the bill proposes to invest $1 billion to build an estimated 2,100 new grocery stores in areas throughout the country of highest need.  On November 30, 2010 the House version was referred to the House Committee on Agriculture and the Senate version was referred to the Committee on Agriculture, Nutrition, and Forestry.

 More recent initiatives:

Food Access Actions of Grocery Stores & Non-Traditional Food Outlets

Selected Stores Selected Actions
7-Eleven Planning to introduce “signature” items and improve overall quality of food beyond traditional convenience store offerings.
ALDI Opening 100 stores in 2011, particularly in Chicago area.  Also opened a new store in New York City and has plans to open one in the Bronx.  In November 2011, a new store was opened in an under-served DC neighborhood.
CVS Increasingly, these pharmacy outlets are offering fruit, salads, sandwiches, and more packaged and frozen items.  In Chicago, CVS doubled the amount of nonperishable food it sells in 11 stores.  Redesigned CVS stores have also surfaced in urban areas of Boston, Detroit, and New York City.
Kaiser Permante Supports farmers’ markets near their clinics.
Mayberry Foodstuffs A non-chain, urban grocer in Cincinnati offering everyday staples and fresh produce.
Family Dollar Stores Started in Chicago, Detroit, and New York City, offering mostly frozen or packaged foods and is now expanding to offer more grocery options in their urban and rural outlets.
Food 4 Less Opened a store in an under-served area of Chicago.
Food Circus Plans to add three more stores in New Jersey.
Grocery Outlet Plans to open over 15 outlets in 2011.
ShopRite Operates 10 stores in underserved markets.
Safeway Opening six stores in California’s Bay Area and has plans to expand over the coming years.  The Safeway Foundation partnered with the Children’s Hospital & Research Center Oakland to develop community or clinic-based programs designed to reduce the burden of childhood obesity.  Their RFP will support NGOs with innovative applications that address childhood obesity.
Shamrock Foods Opening warehouse retail stores in Albuquerque, New Mexico and Denver, Colorado.  No membership is required.
Supervalu (owns Save-A-Lot) Provides fewer items but aims to expand into under-served communities, particularly in the Chicago area.  Also partners with the University of Chicago to teach customers how to shop for healthy foods in underserved areas using shopping tours.  The St. Louis-based grocery store opened up five new stores in Chicago and has plans to open an additional 30 more stores in Chicago over the next four years.  New Florida locations have opened too.  The new stores have improved access to healthy foods and created 150 new permanent jobs, along with construction jobs during the building phases.
Target Increasing grocery offerings in over 380 stores in 2011 and investing over $500 million on retrofitting its general merchandise stores to offer full food sections.  Canadian stores offer more and more perishable foods.
Walgreens Chicago Mayor Richard Daley asked this Deerfield, IL company to increase its food offerings in under-served communities.  Walgreens has opened pilot stores in under-served Chicago and New York City areas with over 500 expanded food options.
Walmart Launching various initiatives including opening smaller Neighborhood Market and Walmart Express stores with groceries throughout US cities.  Four to five smaller stores may open soon in Reno, Nevada and one may open in Menomonee Falls, Wisconsin.

More recent store initiatives:

Organizations Working to Improve Food Access in Under-Served Communities*

Selected Organizations Selected Actions
American Planning Association
Working to advance the role of comprehensive plans that address food access, as well as training current and future planners on examining and addressing food access issues.
Colorado Health Foundation Provided a $500,000 grant to the Denver Department of Environmental Health to help finance grocery stores in under-served areas.  Also in Colorado, the Valley Food Partnership facilitates local farmers to bring their produce into area homes, schools, restaurants, and a local hospital cafeteria.
California Endowment Supporting the California Healthy Food Financing Initiative.
Community Food Security Coalition Building awareness of and grassroots support for healthy food financing initiatives.
Community Health Councils Working on promotion and advocacy of strategies to address food access issues.
Center for Closing the Health Gap Advocating for and increasing awareness around food access issues.
DC Hunger Solutions Working to create a hunger-free DC, including various advocacy efforts to address DC grocery gaps.  A DC Hunger Solution report documented grocery gaps in the District and set forth a number of recommendations to increase full-service grocers in under-served areas of the District.
Healthy Corner Store Network Maintaining a large network of stakeholders working to improve access to healthy foods and beverages available at corner stores or smaller store venues
Food Desert Action Launching Fresh Moves, a program using renovated city buses to bring fresh produce to underserved areas of Chicago.
Food Research and Action Center Leading anti-hunger advocacy providing reports and resources to advance legislative initiatives bringing food retail to underserved areas
Jewish communities and organizations Working to address food access issues in at-risk communities in a variety of cities across the country.
Literacy for Environmental Justice Aiming to increase access to healthy foods in under-served areas through their Good Neighbor Program.
National Policy and Legal Network Providing legal guidance and resources on land use and relevant levers for healthy food financing initiatives.
PolicyLink Advocating for healthy food financing initiatives at the local, state, and federal levels. Partnering on a Robert Wood Johnson Foundation funded evaluation of the development of new California-based stores, financed through a state-based financing program.
Robert Wood Johnson Foundation Funding research examining the effects of healthy food financing initiatives.
Sarah Samuels & Associates Partnering on a Robert Wood Johnson Foundation funded evaluation of the development of new California-based stores, financed through a state-based financing program.
Social Compact Partnering on the California FreshWorks Fund.
The Food Trust Leading the way through partnerships and technical assistance for local and state governments to use healthy food financing initiatives to bring supermarkets and other food retail outlets to under-served areas throughout the US and shaping most local, state, and federal healthy food financing initiatives.
The Reinvestment Fund Creating tools and technical assistance to identify communities under-served by food retail.  Providing technical assistance and support for financing food retail in under-served areas.
Unite 4 Healthy Neighborhoods Working in Columbia, MO to address food access issues, particularly for elderly and people without cars.
US Green Building Council Considering and has created food-related retailer benchmarks for green building standards

*Insights on the identification and description of organizations came from Rebecca Flournoy of Policy Link and Latetia Moore at the Centers for Disease Control and Prevention at the US Department of Health and Human Services.

More Recent Initiatives:

Healthy Corner or Country Stores

Work with your local corner, convenience, or country stores to develop feasible strategies to offer and sell more produce, whole grains, and low-fat dairy options.  Join the Healthy Corner Store Network to learn about a variety of corner store programs happening within North Carolina and across the US!  Explore how research and innovative industry approaches work in a number of cities, including on Indian reservations at the Healthy Store Project.  Contact Diane Beth at the NC Department of Health and Human Services to learn about the state resources available to get healthier foods into North Carolina convenience stores.  Camillia Easley (camellia.easley@dhhs.nc.gov, 919-707-5207) is currently working on a Corner Store Initiative in Durham, NC.   

Corner stores specific initiatives generally work to help get healthy foods items distributed to the smaller store venues.  Efforts also focus on creating affordable pricing strategies for both the retailer and the customer.  Healthy Food Financing Initiatives have been used to retrofit corner stores to have appropriate storage, refrigeration, and lighting to regularly sell produce, low-fat dairy, and ready-to-eat deli sandwiches and salads.  Promotional materials, tailored to local and Native values, also help ensure foods brought into the store get into the homes!  Simply strategies like moving fruit closer to or on the counter help!  Various initiatives are trying to come up with nutrition standards for corner stores.  One good benchmark to strive for is getting all corner stores WIC eligible retailers!  Often, smaller stores greatly appreciate technical assistance and resources around handling, displaying, and promoting healthy foods.  Google Healthy Foods Here Produce Guide to download user-friendly resources on how to handle, store, and display fruits and vegetables from the US Department of Health and Human Services and Public Health-Seattle & King County.  Another toolkit for healthy corner stores is focused on New Orleans but provides good tips and ideas for North Carolina country stores.  Recently, the Ohio State University Center for Farmland Policy Innovation released a Research Brief compiling best practices for establishing and operating healthy corner stores.

Volunteer-oriented corner store example:  In New Haven, CT, three corner stores are working with volunteers from the Community Alliance for Research and Engagement at Yale University and the New Haven Health Department on a New Haven Healthy Corner Store Initiative.  This volunteer-oriented initiative is using free labor to help rearrange store shelves to feature healthier items and tag healthier items with initiative green stickers.

Other examples:

Healthy Stores Project in Indian country

Learn about Apache Healthy Stores and the Healthy Stores program for Navajo Nation at the Healthy Stores Project!  Both programs are using innovative approaches to integrate traditional foods and promotion techniques to improve availability of healthy foods in small and large local stores.  Efforts to link farmers to local stores are being explored!

Online & Mobile Grocery Distribution Options

A growing number of communities and companies are exploring how online ordering and mobile grocery distribution options can help bring fresh food regularly to under-served areas.  Two new tribal initiatives are emerging using mobile grocery options in Santo Domingo Tribe (New Mexico) and White Earth Nation (Minnesota)!  Learn more about the launch of MoGro in April 2011 at Santo Domingo Pueblo, New Mexico.  Contact Shane Plumer, the Wellness Project Coordinator at White Earth Nation, to learn more about White Earth Nation’s initiative at:  218-983-3285, ext. 5855.

Other mobile examples include:

Street of Dreams documents some of the policy facilitators and barriers across the country for food trucks, particularly those serving hot meals.

Explore online providers or tribal members who can develop online/virtual grocery distribution systems!  Work with local food safety authorities to ensure food trucks and mobile vending are in compliance with local food safety laws, particularly when hot food is served.

Grocery Shopping on a Budget

The cost of food, particularly healthier food options such as whole grain cereals and produce, were identified as a barrier to healthy eating by community members.  The US Department of Agriculture forecasts 3-4% increases in US food prices.  Media outlets continue to report raising commodity prices and food companies, such as General Mills, Kellogg, and Unilever, plan to raise prices.  According to an NPD Group, grocery prices are also increasing at faster rates than restaurant prices.  The 2011 Food and Agriculture Organization of the United Nations food insecurity report also indicates global food prices will continue to rise and be unstable.

Promote Participation in Federal Food Assistance Programs

As a tribal leader, consider promoting awareness and participation among eligible families and children in federal food assistance programs.  To help supplement food purchases in the grocery store, eligible families and children may qualify for the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, or Women, Infants, and Children (WIC).  US Department of Agriculture routinely awards grants to local governments and non-for-profit organizations to develop SNAP application and eligibility systems that encourage participation.  Consider applying!

The USDA is currently implementing initiatives to help improve the quality and affordability of foods for program participants.  Examples include:

Equally as important, ensure all local stores accept WIC and SNAP.  A store must apply to the US Department of Agriculture-Food and Nutrition Service to receive a SNAP permit and must continue to comply with program rules and regulations in order to maintain eligibility and be reauthorized at least once every five years (www.fns.usda/gov/snap).  To be SNAP eligible, a store must offer for sale on a continuous basis at least three varieties of qualifying foods:  bread/cereals, dairy products, fruits and vegetables, and meat, fish, and poultry.  At least two of the three offered categories must be perishable foods.  Alternatively, a store can be eligible if over 50% of its total gross sales in staple foods (not candy, carbonated and noncarbonated drinks, coffee, condiments, prepared, ready-to-eat foods, spices, and tea).  Stores can also not allow customers to purchase beer, wine, liquor, tobacco, cigarettes, foods that are point at the point of sale, foods to be eaten in the store, vitamins, medicines, and non-food items with SNAP benefits.  Stores cannot restrict SNAP customers to shop at certain times or in certain lanes, require customers to make minimum purchases, charge sales tax on SNAP transactions, or give cash in exchange for SNAP benefits.

To become a WIC vendor, a store applies to the North Carolina Department of Health and Human Services.  WIC vendors must stock required levels of WIC approved items at all times and to the terms of agreement set forth by the State.  North Carolina WIC Vendor Connection provides more detail.

Share Cost & Time Saving Shopping Tips

Print and post on your tribal office walls or on your website tips and tricks for purchasing affordable healthy foods.  Here are a few suggestions from the Spend Smart. Eat Smart. to get started:

Check out this new website that provides guidance on eating healthy on a budget!  Share Our Strength also provides guidance through their Shopping Matters resources.

Store-Level Strategies

Encourage your tribe to build relationships with local grocery stores and suggest strategies to help tribal members purchase healthy, affordable foods and beverages.  Never hurts to ask and sometimes keep asking!

Some innovative store-level approaches US stores are trying are:

Product-Level Strategies

Healthy Diner Initiative

Recently, the federal government mandated menu labeling in chain restaurants.  Menu labeling laws at the local, state, and federal levels have sparked some industry changes in product development and promotion.  This law does not apply to many smaller diners, grills, and restaurants.  But it never hurts to ask a restaurant for more healthy food items or cooking approaches.  Don’t forget that many tribal members spend more and more time at hospitals; in turn, hospitals also need to be reminded that their food service options should reflect the dietary advice their doctors are providing to their patients!

Many community restaurants noted that folks don’t ask for grilled or baked meat or produce items, even if they are listed on the menu.  Consider working with local food establishments to help establish connections between local farmers and food producers.

Encourage restaurants to offer and promote healthier foods and preparation styles.  Restaurants could offer type 2 diabetes or heart healthy options.  Help them use traditional and social media strategies to highlight their healthier fare at affordable prices.

Consider example healthy dining programs as food for thought!  The Healthy Dining New Bedford Program has created a decal to help customers eat healthier and encourages participating restaurants to serve smaller portions, tag healthier menu items, and allow for healthy substitutions such as a salad instead of French fries.  In Louisville, KY, over 30 restaurants have voluntarily pledged to post calorie counts and receive financial and technical assistance on recipe analysis.  The program is known as Healthy Hometown menu program.

Encourage tribal youth and families to try to eat at home more often, preparing their own meals and discussing other ways their family and tribe can advance American Indian health!  At restaurants, try to avoid fried foods and heavy sauces.  Substitute French fries for salad or seasonal vegetables.  Aim early to only eat a reasonable portion and take the rest home for another meal!

Explore a local example, known as Feast Down East in southeast North Carolina, trying to connect local farmers with local restaurants.  Whether your a farmer or a restaurant owner, explore ways to increase access to local, healthy foods in your area!

Supermarkets are also increasingly becoming venues for healthy, affordable ready to eat foods.  Work with local grocery stores to promote the accessibility, availability, and affordability of ready to eat options and a community-oriented eating environment within the store setting.

Recent Restaurant Health Initiatives:

Evaluate your Efforts

Learn to maximize your resources and share your process and progress with your community and other interested communities!  Work with research partners to help develop a feasible and meaningful evaluation of your food retailer efforts.  Explore the free assessments tools at the National Collaborative on Childhood Obesity Research.  The evidence base is in its infancy around the range of effects food retailer initiatives can have on health, agriculture, economic, and environmental outcomes.

Share your Story

Media buzz attracts customers!  Maximize traditional and social media outlets to ensure all potential consumers know about your area’s healthy food retail initiatives!  Also disseminate your process and progress at various levels, including state (e.g., Unity Conference and Sustainable Agriculture Conference by Carolina Farm Stewards), regional (e.g., Southern Obesity Summit), and national (e.g. American Public Health Association Annual Conference).  Share American Indian initiatives with other American Indian health and agricultural research groups, along with two leading ethnic minority research organizations, African American Collaborative Obesity Research Network and the Salud America!

Getting Started on Strategies to Increase Healthy Food Retailing in your Community

Learn from existing local, state, and national initiatives, contact potential food industry partners, and explore resources from active organizations at the local, state, and national levels.  And, encourage strategies at the local, state, and national level to: