Weaving through organic aisles to non-organic aisles, grocery shopping for Mattapan-resident Joanna Bell involves a strategic exercise of number-crunching spinach prices and comparing the unit values of lemonade, while keeping the sugar content in mind for her diabetic mom. Although Bell lives in Mattapan, she chooses to shop at a grocery store in Brookline, near her workplace. She claims the prices are cheaper for the same products in the Brookline Stop-and-Shop compared to the Roxbury Stop-and-Shop; the latter is the closest grocery store to her house in Mattapan.
“My mom doesn’t have a car. So when we do go grocery shopping, we usually take the bus down there and then we take an Uber or something back…And it’s a hassle.” – Joanna Bell, Mattapan Resident
For metropolitan areas in the U.S. like Boston, food deserts — areas that lack access to affordable grocery stores — are a common factor that contribute to the less nutritious diets in urban lower-income neighborhoods.
A recent study published in an August 15, 2016, edition of American Heart Association’s journal, Circulation, found a link between the density of healthy food stores around an individual’s home and subclinical atherosclerosis, or early stages of plaque formation in the arteries. This was after the results were adjusted for “age, marital status, income, working status and CT scanner type.”
The study’s co-lead author Ella August explained the findings in a ScienceDaily article, “We found that healthy food stores within one mile of their home was the only significant factor that reduced or slowed the progression of calcium buildup in coronary arteries.”
“Our results point to a need for greater awareness of the potential health threat posed by the scarcity of healthy grocery options in certain neighborhoods,” August added.
“1 in 6 Bostonians don’t know where their next meal is coming from.” – Catherine Drennan, Greater Boston Food Bank
According to the “Health of Boston”, a 2014-2015 report by the Boston Public Health Commission, Boston had a lower than average modified retail food environment index (mRFEI). The mRFEI is a percentage score based off the number of food retailers that are healthy out of all food retailers in a census tract. Census tracts are subdivisions within a county, and the census tracts in Suffolk County provide a distinct picture as to the disparity in access to healthy food retailers among various neighborhoods.
Boston had a mRFEI score of 6 percent, meaning an average of 6 percent of the food retailers in Boston’s different neighborhoods sold healthy food. In comparison, Boston has less food retailers selling healthy food compared to the rest of Massachusetts. The median score of healthy food retailers for all 50 states of the U.S. and Washington D.C. was 10 percent.
Rep. Byron Rushing (D), House Majority Whip of Massachusetts, co-chairs the state’s Health Disparities Council. The advisory council provides suggestions on improving racial health disparities to state agencies – public health, transportation, etc, based off data that has been collected.
“When we talk about health disparities, we’re starting from the basis of the healthy individuals and why their health is different than the health of other individuals.”
In a study by Virginia Commonwealth University, researchers studied census tracts in Boston and found the neighborhood with the shortest life expectancy bordered a neighborhood with a life expectancy above the Boston average. The neighborhood with the shortest life expectancy was Roxbury (between Massachusetts Avenue and Dudley Street, Shawmut Avenue and Albany Street) at 58.9 years, which is lower than the life expectancy in Iraq.
The Roxbury census tract was 45.7 percent Black and had a median income of $35,458. Just across Massachusetts Avenue, residents in the bordering South End neighborhood had a life expectancy of 84.2 years. This area’s population was 15.9 percent Black and had a median income of $42,627.
While the difference in median incomes is only $7,169, the life expectancies differ by 25.3 years.
A 2011 report published by the Massachusetts Health Disparities Council reported that Black-Americans in Boston fared worse in cardiovascular disease, obesity, coronary heart disease and diabetes-related deaths. Both Black and Hispanic-Americans in Boston faced higher prevalence rates of diabetes. Hispanic-Americans in Boston also ate “significantly less fruits and vegetables.”
White-Americans in Boston’s lower-income neighborhoods also fared worse than White-Americans in upper-income neighborhoods. In Roxbury, the leading cause of death for White-Americans was heart disease, with 82 deaths caused by heart disease from 2007 to 2010. Forty-three White-Americans in the higher-income neighborhood of Fenway died from heart disease from 2006 to 2010.
BPHC reported that social determinants of health “are actually stronger predictors of health than any of the individual factors.”
Being able to access affordable healthy food is an example of a social determinant of health that affects lower income neighborhoods such as Roxbury, Mattapan and Dorchester.
Arielle Thomas, a University of North Carolina – Chapel Hill medical student and Yale University masters of public health candidate said that the combination of food deserts and food swamps — areas with abundant fast food options, leads to poor health outcomes.
“Diabetes is a common health problem…It’s hard to control blood sugar when your meals are uncertain or high in sugar, cholesterol and fat. It also plays a role in cardiovascular health because of the same link between choosing fast food, and those food choices are high in cholesterol.”
“With no grocery stores you end up in a food swamp where there are 10 fast food restaurants for you to get food so you get used to accessing low-quality, but easy food.”
Bell agreed regarding the prevalence and affordability of fast food restaurants in her area, compared to grocery stores.
She said, “Especially if you’re only walking around with five dollars for lunch, you’re going to get the four dollar meal at Wendy’s and nine dollars for salad. I would most likely choose the cheaper option which is the fast food.”
The Greater Boston Food Bank provides nutritional assistance for Boston-area residents who define themselves as food-insecure. Food insecurity can be defined by not knowing where one’s next meal will come from. The three factors affecting food insecurity include availability of produce in regions, affordability of produce in nearby grocery stores and accessibility of healthy food retailers. Out of the three, affordability and accessibility affect Boston’s food-insecure population the most.
Catherine Drennan, public and government relations manager at the Greater Boston Food Bank, said the organization launched a public health initiative last year to “look at the connection between hunger and health, and connect the dots between the two.”
“What our director of public health and research, Dr. Pedowsky has been doing is screening for food insecurity among community health center patients. He’s found a really high percentage of patients who identify as food-insecure also suffer from many chronic diseases such as diabetes and heart disease,” said Drennan.
Tajh Donaldson, a resident of the Dorchester neighborhood, said, “People are going to eat what’s good to them. That’s what they used to. And there’s these things around you that taste good. Why you gonna go further for something that doesn’t taste good to you?”
Thomas added, “Lower class neighborhoods also have poor access due to job timing — they don’t get out of work in time or work odd hours, and often rely on public transportation, which makes it difficult to travel after work and at times it can be unsafe to travel at night. Also, lack of transportation limits how much food one can carry at once.”
Rushing spoke of the greater stress on families in lower-income neighborhoods.
“You pick your child up from daycare. You’re coming home and your child wants a snack. You have to be prepared to be carrying this healthy snack all day, and then you go passing this fast food restaurant, what do you do? You try to go in there and get the least damaging food as possible,” he said.
Rushing remarked, “We advertise ourselves as being the greatest country in the world. So how could the greatest country in the world not have the greatest eating habits in the world?”
He also mentioned that immigrants are a population who “tend to get less healthy when they come to America.
“You have a population where if you could meet them at an early point, you could encourage them to maintain a lot of the cultural eating habits that they have and not succumb to the eating habits of Americans,” he said.
“One of the pieces of that I would support and think would be a very good idea to investigate is to be sure to be selling the food that immigrants are comfortable of seeing as the food they eat.”
Donaldson wanted to see more elected officials who have lived in food deserts, and had a creative idea of his own.
“Maybe if you [the government] throw a cookout, like a healthy barbeque or something like that…And you can use that opportunity to spread awareness — even pass out recipes.”
Rushing added, “We still haven’t gotten enough of a curricular of med schools to see this as something to integrate in all of their teaching. They should always be looking — teaching their students, these new doctors, and then looking for ways in which disparities are going on in the way they serve their patients.”
The Massachusetts Health Disparities Council developed a set of guidelines titled “A Framework for Eliminating Health Disparities in the Commonwealth of Massachusetts.”
While Massachusetts leads other states in setting goals, collecting data and identifying sources of health disparity, Rushing finds the stalled progress frustrating.
“When we did the best here it’s because we had a secretary of health and human services who saw this as her highest priority, but her successor did not…Right now, we’re in one of those periods where this is not a high priority inside places like the department of public health.”
A Brown University analysis of the 2010 U.S. Census found that Boston-Quincy was ranked 11th in most segregated for Black-American populations and 4th most segregated for Hispanic-American populations. Lower-income neighborhoods such as Dorchester, Roxbury and East Boston have a large percentage of Black and Hispanic-American residents. Residents with lower-income are disproportionately affected by the higher costs of healthy food.
Rushing, who oversees the mixed-income South End neighborhood, which borders Roxbury and Dorchester, spoke about the problems in gentrified neighborhoods.
“You get the supermarket, but the supermarket is designed for the gentrifiers and not the people they have gentrified. We have on either side of the South End, a Whole Foods. And so that’s accessible, but you’re going to pay even more money for this food,” said Rushing.
Rushing said he was able to negotiate with one of the South End Whole Foods stores into providing a discount for elderly residents.
While Rushing spoke of gentrification, he felt income integration was integral in alleviating poverty.
He elaborated that middle class to wealthy White people have been moving into the South End, often times a block away from public housing units. Because of that, he reasoned that public housing units should be built in more affluent suburbs such that lower-income Bostonians can have access to healthier food outlets, as well as other opportunities.
“We can show it to you that it’s safe, but if we asked to put that many poor people in Winchester, whatever elected official suggests that would not be an elected official in two years,” he said.
Josh Trautwein, executive director of the Fresh Truck, a truck that drives through Boston’s neighborhoods and sells wholesale produce for lower-than-market prices, weighed in on factors he believes affects food accessibility.
“When I first started out my own research around this issue, I was really finding that the high-level research from the USDA and different organizations around the country were using the geographic location of grocery stores as a proxy for food access,” said Trautwein.
“I think that’s just over-simplifying the equation of as to whether a family has access to healthy food. A lot of times it doesn’t take into account car ridership. It doesn’t take into account the mobility of a family and their ability, whether it’s time constraints or whether it’s issues like public safety.”
Christian Peters, an associate professor at Tufts University Friedman School of Nutrition Policy, participated in the United States Department of Agriculture (USDA)-funded project titled “Enhancing Food Security of Underserved Populations in the Northeast Through Sustainable Regional Food Systems.” The research project looked at various regions’ capacity to supply food, as well as the consumers’ access to affordable food.
During a community-researcher workshop that was a part of the project, members of the community, including grocery store managers and owners spoke about the issues they faced.
Peters said, “All of these grocery stores were located in either mixed-income or lower-income communities. One of the things that came up was the seasonality over the course of a month with their customers’ access to SNAP benefits.”
“And at certain times of the month, people essentially had more resources than at others…That’s just going to influence what you’re going to see on the shelves, and it’s a challenge for someone who’s running a grocery store to be able to do.”
SNAP, or the Supplemental Nutrition Assistance Program, offers food assistance and economic benefits to lower-income populations, and is funded by the USDA.
However, critics question whether SNAP even benefits it’s users.The Right to Know Committee from the Association of Health Care Journalists, among other groups have scrutinized the USDA for its secrecy surrounding the SNAP program. The USDA had claimed that a federal law which protects SNAP-participating retailers’ applications, outlawed the release of information surrounding sales amounts.
On December 2, 2016, a federal judge granted a Freedom of Information Act (FOIA) request, ordering the USDA to reveal annual sales amounts of every business in the nation that participates in SNAP. The information should also reveal what food and drink items that food stamp recipients are purchasing and how healthy the options are at SNAP-participating retailers. Health journalists believe this information will reveal whether “SNAP recipients have access to healthful foods.”
Rushing said that there are “very few” programs for food assistance, but that there had been creative work done in field for the past four to five years.
The Greater Boston Food Bank, for example, is a hunger-relief organization that provides more than 58 million pounds of food to 190 cities and towns across eastern Massachusetts.
The food bank works with food pantries, shelters, and meal programs, as well as five direct-service programs. These direct-service programs include mobile markets at community colleges and community health centers, brown bag programs and pantries in schools.
Rushing suggested the idea of the state government opening up grocery stores where private markets are scarce, modelling after other states where government-owned stores sell liquor.
Peters added, “A lot of the food businesses are really long established. It’s grocery chains. I don’t know how much room there is for entrepreneurs to get in there.”
“It has gotten a little better here in Boston. It’s not as bad as it was when I came. I tell everybody this. Nobody can believe this. But we used to have a used food store,” said Rushing.
Rushing elaborated, “There was a food store in the middle of Roxbury on Blue Hill Avenue that specialized in buying up the canned [goods] from stores that were going out of business or stores that had fires. So everything with all the labels were smoky….and they sold relatively inexpensive food in these places, but essentially that is quite different than having, you know, a full-scale of a supermarket, right?”
Trautwein added, “If you’re only making one trip to the grocery store every month, a week, whatever it might be, you’re probably less likely to buy perishable food items. So if you’re buying in favor of food items that are shelf-stable, there’s a high likelihood too that the food is probably going to be a little less-nutrient dense.”
Entrepreneurs like Trautwein are now squeezing into the grocery store industry by identifying gaps in service and serving people affected by those gaps. Fresh Truck converted two school buses into mobile food markets and interactive educational learning spaces.
He explained that he came up with the concept after seeing the only grocery store in the Charlestown neighborhood bought out by Whole Foods. He was working as a program manager and nutrition educator in an area health center at the time and saw that his families did not have access to healthy food.
“We’re perhaps a more culturally-relevant model for food retail than a lot of traditional grocery stores…We’re able to switch up our inventory to meet the taste of the neighborhood that we’re in and adjust the way we develop programming too,” Trautwein said.
“I think there’s a lot of false assumptions on the part of grocers and the way that they’re calculating the sort of total addressable market for groceries.”
Trautwein pointed to a study out of Harvard Business School by Michael Porter.
“He [Porter] made the case that there was a really robust development context for a grocery store in Grove Hall. So Stop and Shop moved in and it ended up being a really profitable store for Stop and Shop,” said Trautwein.
The Fresh Truck is a non-profit and is able to subsidize their overhead costs through corporate sponsorships and strategic partnerships with healthcare agencies. Healthcare providers, social service agencies and housing agencies can even pre-purchase gift cards from Fresh Truck and give them to families.
But not all affordable options are new. Haymarket, an outdoor market selling retail food at bargain prices, has been a Boston tradition for nearly 300 years. The market is usually open on Thursdays, Fridays and Saturdays.
Haymarket Pushcart Association president Otto Gallotto explained that they buy wholesale products from the Chelsea Produce Center earlier in the week.
But what really attracts customers are the prices.
Saturdays are especially filled with deals as the push cart owners have to sell off all of their merchandise by the end of the night. For example, shoppers can take boxes of 10 oranges for only $1.
Gallotto said, “People from Beacon Hill, people from Roxbury…I have the same couple from Maine. They know they can get a bang on their buck.”
The Haymarket is accessible by public transportation — Green line, Orange line, several bus lines, and they tweet updates regarding public transportation on their Twitter account.
“I’m only optimistic because I’ve read about times where it was incredibly worse. And I think we need to hear about those times. It’s important to talk about that.” said Rushing.
Karishma B. Desai is an emerging broadcast journalist interested in covering health, international and public interest stories. Desai is currently studying her M.S. in Journalism at Boston University. She also freelances as a web producer at New England Cable News. She hopes to use her skills in journalism to shed light on issues regarding mental health and disparities in health outcomes. In her free time, she enjoys dancing, chugging coffee, reading, writing and exercising.
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