Be Well: Easy Access to Healthy Food Doesn't Necessarily Equal Healthier Neighborhoods

by Sarah Jane Tribble

The federal government’s food access map for the city of Cleveland shows a vast swath of orange neighborhoods, streets where fresh food is considered difficult for low income residents to reach. 

Twenty-eight year old Jacory Stone grew up in one of those orange neighborhoods.

“Pretty much every corner you turn to, you see a liquor store and things of that sort," says Stone, who grew up in the Glenville neighborhood on the city's east side. "You would see a liquor store before you would a grocery store and that’s, it’s kind of mind boggling a little bit.”

On Cleveland’s near west side, Kayla Ragobear’s family lived in the Tremont neighborhood for generations before a slew of trendy restaurants moved in. 

“Who can afford these restaurants and who can afford the healthy food?" Ragobear says. "You know if you come here on a Saturday or any corner store on a Saturday, after school, they’ll come in for the 25 cent bag of chips or the candy. I don’t think we ever talk down here that you have to eat healthy food.” 

Across Cleveland, work is being done to change the orange map where residents like Jacory and Ragobear live. In neighborhoods where fast and highly processed foods are the main stay of many diets, hundreds of thousands of federal, state and local dollars are being spent on projects that include: 

-    Establishing a new East Side Market grocery.
-    Financing small fresh food markets, like the one planned attached to the St. Clair-Superior project called Hub 55.
-    Placing farmers markets in low-income neighborhoods.
-    And putting fresh fruits and vegetables in corner stores and local shops, particularly on Cleveland’s near West Side. 

Erika Trapl, an associate director at the Prevention Research Center for Healthy Neighborhoods at Case Western Reserve University, says it’s not enough to simply put the fresh food in a local shop. 

"Let me be the first to say that I don’t think a healthy corner store is going to immediately change the diets and chronic disease outcomes of any neighborhood in Cleveland," Trapl says. "But I think it starts to change the story around what folks see in their neighborhood and what folks see in their environment and how folks think about the foods they eat." 

A key aspect to the projects may be education and connecting with the community, Trapl says. 

"Just because we build it, it's not going to get folks there. That's just one piece of healthy food access," she says. "We have to have something there in order for folks to get there. But we also need to find ways to get folks into these opportunities that we're creating in these environments." 

One of the  largest U.S. studies to date on what happens when a food desert disappears was released last year. Researchers at the RAND Corporation followed the opening of a full-service grocery store in a low-income district in Pittsburgh. Researchers interviewed nearly 1,400 residents in two neighborhoods over five years. One neighborhood never received a new grocery store, the other did. 

The results, says lead researcher Tamara Dubowitz, were confusing. It wasn’t as simple as putting fresh food in a store and residents flocking to buy it.

Instead, residents in the neighborhood that did get full-service grocery did not shift their shopping patterns significantly and they did not eat more fresh or whole foods. Indeed, there was a decrease in fruit and vegetable and whole grain intake

"So we looked a bit deeper into this and said, 'OK' we're seeing these differences and they were definitely statistically significant differences. What is going on?" Dubowitz says. 
 
The data also revealed positive news for the residents who lived in the neighborhood with a new full-service grocery: Residents did report a decrease in their intake of empty calories from solid fats, alcohol and added sugar. In other words, they probably drank less sugary drinks and ate less fried food after the grocery store was built. Dubowitz says they are still digging into that numbers.

But the data also revealed something else: It showed a significant difference in how residents viewed their neighborhood. Before the grocery store opened in 2011, about 66 percent of residents said they were either satisfied or very satisfied with their neighborhood. After it opened in 2014, 80 percent of residents responded positively.

Dubowitz pointed to the marketing blitz around the new store opening as a possible influencing factor in residents’ perceptions and shifting eating habits. 

"Just the knowledge alone that they deserve access to healthy options was something that was almost networked throughout the community as an increased sense of awareness," she says. Residents, Dubowitz says, began saying "we deserve more and why do we deserve more, because we deserve a better future."  

In other words, just the presence of healthy food didn't mean residents would buy it. But it made residents rethink the amount of nutritious food that they were putting in their bodies.

"If we're looking at health and nutrition holistically, we're seeing positive results. But if we think these results are happening because people are changing their purchasing habits and their diet because all the sudden people have access to health foods, that's not quite right," Dubowitz says. 

Researchers like Dubowitz and Trapl are trying to figure out what motivates people to buy and eat the healthy food once it is in their neighborhood. Trapl says community leaders in Cleveland are “trying to figure out the right way to work together” and coordinate a comprehensive plan for healthy food access that would track and study all of the efforts across the city.

Meanwhile, store owners and advocates in Cleveland are taking a grassroots approach to answering the research question of what will people buy and eat.  

It's a question Willie Austin, president and CEO of NEON hopes to answer after the East Side Market reopens at East 105th and St. Clair later this year.

NEON, Northeast Ohio Neighborhood Health Services, is leasing the long closed property from the city for $1 a year. The community health center plans to fund a $3.5 million renovation with public and private funding, installing a satellite health clinic as well as a full-service grocery. 

"I've been aware of the emptiness of that marketplace for years as I drove by," Austin says. "I was trying to figure out what it is that we can do to maybe be of some assistance to the neighborhood and of course providing primary care in a holistic manner." 

A nutritionist will be available as well as occasional cooking demonstrations to tempt residents to buy the food, he says.

"We know that our folks have become more obese and often some of the health deterioration has to do with what they're putting in they're putting in their bodies also. It just seems like a natural fit if we could influence eating habits, we would like to do so. How natural is it to have your own market to come into the neighborhood?"

And smaller scale experiment is underway on Cleveland's near west side. 

Lindsay Smetana is a community organizer and program manager for Tremont West Development Corp. This summer, she says, will be the group's fourth year of installing fresh produce coolers at corner stores in neighborhoods that lack food security. 

 "There are those who go to the store just for convenient shopping and they still grab like a fruit salad, the value added things that are easy to eat because they are more health conscious. There are also families that this is where they are going for everything," Smetana says. The project has five stores and Smetana says she checks them regularly to see how the fresh fruit and vegetables are selling.

Smetana says she would like to begin to do more community engagement activities with the stores, offering programs that bring residents in and gives them an opportunity to share their thoughts on the food.

One of the stores in the Tremont project is Caribe Bakery in Cleveland's Clark-Fulton neighborhood. 

On a recent weekday morning at the bakery, Judith Tecillo scoops up plates of fried turnovers filled with pork and yellow rice while taking to-go orders and ringing up the cashier. The line ebbs and flows as families with kids line up behind neighborhood regulars.  

And beside the line, there is a cooler case filled with heads of lettuce, tomatoes, limes and onions. During a break, Tecillo walks over and explains that Smetana had approached them to install the case.

“I didn’t think it was going to work and it’s working out pretty good," Tecillo says during a break. "People do come in and grab their tomatoes and their stuff." 

The fresh food is selling. Customers even ask for salads to be chopped up and put on their plates, Tecillo says.

There may not yet be peer-reviewed data to Tecillo and others to keep selling the healthy food. But - as evidenced at Caribe - there is anecdotal evidence. 

Tecillo says she no longer eat the food behind the counter. Instead, she reaches into the produce cooler for lunch. 

And, she has lost weight.