Summary:
This document relates to the pressing need to support better access to healthier food in the town of Springfield, Massachusetts suggested by Civics Works. Civics Works/Real Food Farm is a mobile food retail organization established in Baltimore, Maryland to help people living in food deserts have the ability to shop for fresh produce. Real Food Farm “strives to improve food access in Northeast Baltimore by focusing on pricing, proximity, and familiarity”. (realfoodfarm.civicworks.com, 2018) This
suggestion for mobile food retail stems from Real Food Farm’s past success in helping lower socioeconomic citizens in Baltimore increase availability to foods of nutritional value.
Background:
A balanced diet is essential for proper growth, the development of children, and maintaining a healthy lifestyle for adults. A habit that develops into healthy eating starts during childhood and ,therefore, promotes optimal health and positive outcomes in the long run. This plays a significant role in the prevention of health problems such as nutritional deficiencies, diabetes, heart disease, and most importantly: obesity.
Regarding what was mentioned above, Springfield residents experience numerous inequities in factors that impact their health and hinder the ability to create gain access to healthier food options.
Concern:
As an epidemic, obesity is a growing national concern contributing to a multitude of diseases such as heart diseases, cancer, and diabetes. There are many determinants that go into whether an individual will develop obesity. Besides genetic factors, dietary intake is a main promoter of obesity. In a cohort study, the main cause of weight gain was from “dietary fat [especially] when there was a increase in animal, saturated, and trans fat such as red meats or fried foods”. (Hruby, 2016, p.1656) In
addition, an increase in sugar-sweetened beverages intake and refined foods such as potato chips was associated with greater weight gain. (Hruby, 2016, p.1656) Contrarily, the same study found that “individuals who increased intake of vegetables, fruits, whole grains, nuts, or yogurt in the same period experienced less weight gain”. (Hruby, 2016, p. 1657) That being said, the consequences of obesity are tremendous. Obesity is associated with major causes of disabilities, chronic diseases, and death.
The "national yearly cost of obesity-related illnesses is around $190.2 billion” (Taylor, 2010, p.1188) which is around $1,429 higher than those who have a normal weight. (CDC, 2014) Moreover, prevalence rates for obesity are greater in areas where there are minorities, lower socioeconomic status, and rural populations. According to the CDC, the “prevalence of obesity is 38.9% ” while “Hispanics and non-Hispanic blacks had the highest prevalence of obesity [being] 47.0% and 46.8%” perspectively.
(CDC, 2018)
Compared to the entire state of Massachusetts, it was reported that “Springfield children and adults experience obesity rates greater than that of the state ”. (Szegda, 2014, p. 11) Furthermore, “67% of Springfield adults are overweight or obese, as compared to the 59% overall in the state”.(Szegda, 2014, p. 12) This does not include the other consequences that stem from obesity seen in Springfield residence. Based on the Springfield Equity Report, residents were “estimated to have a 12% prevalence
rate of diabetes which is 50% higher than the prevalence rate of the state overall.” Szegda, 2014, p. 10)
As mentioned above, one determinant of obesity is dietary intake. Another determinant can be lower socioeconomic status. A majority of Springfield households struggle economically “with an estimated median household income of $31,356, which is less than half than that of the state”. Szegda, 2014, p. 12) That being said, 1/3 of the residents of Springfield have an income that fall below the income poverty line. This lack of financial resources directly affects the ability to access resources that
can better their health such as healthcare and food access.
Limited access to food can be defined as a “limited access to supermarkets, super-centers, grocery stores, or other sources of healthy and affordable food retailers”. (USDA, 2012)) This may make it harder for Americans to obtain a healthy diet. Limited access can be determined by distance of store, income, presence of a vehicle, and availability of transportation. (USDA, 2012) These areas that struggle with limited food access are called “food deserts” According to the American Nutrition Association,
the “USDA defines food deserts as parts of the country that are vapid of fresh fruits, vegetables, and other healthful whole foods, usually found in impoverished areas”. (American Nutrition Association, 2011) As a result, people who live in these areas resort to local convenient stores where there is only processed foods that are higher in sugar and fat. This goes hand in hand with the obesity epidemic that the United States is facing today.
Access to affordable, healthy food is an important determinant of health that contributes to health inequities. Nonetheless, Springfield currently struggles with food access and is currently regarded as a food desert. (Szegda, 2014, p. 9) In fact, Springfield comes second when speaking of top Massachusetts Cities with the most significant grocery gap. (Mapubhealth.org, 2017) The predominately African American population in Springfield have been seen to “more likely shop at convenience stores that
have chips and cookies than spinach and cauliflower [resulting] in witnessing neighbors with limbs lost to diabetes and high obesity among the community children”. (Freyer, 2017)
The unequal distribution of health promotion resources contribute to disparities seen in Springfield, Massachusetts.
Recommendations:
Since lack of access to healthier food is taking a dramatic effect on the obesity rates and thus leading to further health consequences, it is pertinent to address this issue in the town of Springfield. It is recommended that to prevent further incidence rates of obesity in Springfield, Massachusetts, one must start with increasing access to healthier foods. A policy that can alleviate this problem can be the use of mobile food retailers. These retailers can be comprised of multiple vendors
who sell food out of a movable vehicle. The foods offered are comprised of healthier obtains such as fresh produce and whole grain foods. Food vendors should be located in central areas of the town where most people are located and can easily have access to these areas. This could be near schools or public parks where adults can go grocery shopping either before, after, or while their children are at school. This is necessary because “lower income families are less likely to have access
to nutritious foods and have a higher risk of not meeting [nutritional] recommendations” mainly because of “limited access to high-quality foods based on high cost of foods, as well as limited numbers of grocery stores in low income neighborhoods”. (Kranz, 2009, p. 703) It is also noted that “higher vegetable consumption can contribute to lower body weight in children and adults due to high water content and saturating value of vegetables”. (Kranz, 2009, p. 703) In a research done on examining childhood
obesity in Roosevelt, New York, it identified that “farmer’s markets that provided healthy food to their community was considered the best local asset.” (Hackett, 2015, p. 250) The same study showed that “youth in the area identified barriers to health food choices as a theme and pointed out corner stores and the frustration of having limited options”. (Hackett, 2015, p. 251) Youth also observed that there was only food market in town and since the other markets that sold healthier options resided
in more affluent communities, it was difficult to get there due to lack of public transportation. This data supports that interventions to increase access to healthier options to a community such as farmer’s markets and (potentially) mobile food vehicles in underserved areas such as Springfield can improve diet quality and reduce the risk of obesity
Regarding funding and financial factors, funding to kickstart the program can be done through a micro-loan, especially if the local government of Springfield starts this initiative. This can create the interest of other stakeholders and community partnerships. An example of a similar policy being implemented is the “Michigan Neighborhood Food Mover” in Detroit. Since the power to act was a government action, it produced interest from other people and a $75,000 loan was made to help start the program.
(CDC, 2014) It is also recommended that this policy allows a wide variety of payment methods from their customers. This can include accepting Supplemental Nutrition Assistance Programs (SNAP) benefits and Electronic Benefit Transfers (EBT) which not only allow low income residence purchase foods without spending more out-of-pocket money, but also helps mobile food vendors increase revenue to help maintain quality of the vehicle and quality of the food from external retailers.
Advocators/Challengers:
Since interventions to improve better access to healthy food in underserved areas have already been a strong stratagem in the United States, there are many potential supporters. In the past, one major initiative was the “Healthy Food Financing Initiative” implemented by the White House. This $400 million initiative “focused on childhood obesity and interventions were based on the idea that encouraging supermarkets and grocery stores to open in underserved neighborhoods will translate into improvements
in individuals diets”. (Cummins, 2014, p.289) That being said, the White House Task Force can be a strong advocate to national intervention of underserved areas. On a more local level, the “Massachusetts Food Trust Program” is another supporter for mobile food retail. This program was implemented to “increase health affordable food as a means to improve health outcomes and to encourage innovation in healthy food retailing and distribution in nutritionally underserved communities”. (Mass.gov, 2018)
This supporter can be extremely helpful since it takes into consideration of communities where solely costs and credits cannot be suffice financial needs of healthy food retailers. (Mass,gov, 2018) This is done through other funding plans by the MFTP.
Some limitations and barriers to this recommendation can be zoning regulations. While zoning regulations can vary state by state, some rules can be restrictive to mobile vendors. This can present a challenge when it comes to location of vehicle, operation times, and how long it can stay in one place. Another challenge can be that local retailers may have a negative perception on these mobile retail trucks due to competition. These concerns can be addressed by researching previous and existing municipal
codes that either support or hinder mobile retail. In addition, the vendors who sell healthier items can be granted permits in which they can only operate in certain locations to avoid backlash from preexisting stores in the area.
Another way to compact challenges is by education. Simply placing a healthier alternative may not create initiative to live a healthier lifestyle. (Cummins, 2014, p.285) Displaying “the effects of the consequences of obesity significantly increased participants’ perception of the seriousness of obesity”, as reported by the 2012 Institute of Medicine: Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. (Gollust, 2011, p.100) These interventions to similar challenges in
the past have seen "increase in fruit and vegetable intake from 0.6 to 1.13 portions per day”. (Gollust, 2011, p.99)
Conclusion:
Implementing a mobile food retail truck in underserved areas such as Springfield, Massachusetts will not only increase access to nutritionally dense foods, but also prevent chronic diseases such as obesity in children and other diseases seen in adults such as coronary heart disease and diabetes.
Some key administrative aspects to start implementation of this policy can include educating stakeholders about the potential health benefits of increasing access to fresh produce in these areas of lower socioeconomic status. Additional education to stakeholders can also be about local or state policies that could potentially support the idea of a mobile food truck. Another administrative role a public health practitioner could take is to look into economic loans for the purchase of the initial vehicle and additional costs for maintaining the vehicle for optimal use.