Why Health-Care Systems Are Funding (Or Building) Grocery Stores

Access to healthy food can support not only personal health but neighborhood health.

At Carver Market in Atlanta, neighborhood children make a grocery run for mom. (Photo by Lucas Hicks killshotmedia.com; courtesy Build Healthy Places Network)

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It says something about the persistence of food deserts in low-income neighborhoods when the managers of Carver Market, a new grocery store in Historic South Atlanta, have to drive 200 miles roundtrip each week to a small town in Alabama to stock Carver’s shelves.

There’s been a lot of talk and research about the importance of access to healthy food as a social determinant of health. Obesity, diabetes, heart disease — all are linked to diet. So putting a full-service grocery store in the heart of low-income, underresourced neighborhoods, where health disparities are high and persistent, seems like a sensible thing.

It’s why Promedica healthcare system now owns and operates a grocery store in the UpTown neighborhood in Toledo. It’s why Virginia Commonwealth University and Health Systems is locating its “health hub” next door to a new grocery store in East Richmond. And it’s why the managers of Carver Market in Atlanta drive 90 minutes roundtrip just to stock their shelves.

All three also know that the grocery store is integral to not just residents’ health, but to the health of the neighborhood itself. As new research is beginning to show, paradoxically, the indirect effects of a new grocery store on residents’ health are possibly more powerful than the store’s direct effects on their health. For local residents a grocery store is more than a place to buy food. It’s a signal that they matter and that their neighborhood matters. And that, says RAND researcher and food desert expert Andrea Richardson, can translate in numerous ways.

“If residents start to feel that the neighborhood is changing and getting attention, you can imagine how that might make them feel more hopeful, giving them the mental space to make better choices about their diet when things are improving around them,” she said.

A grocery store and its economic boost can also jumpstart other commercial activity in the neighborhood, and all that can have downstream effects in supporting residents’ health, she added.

But building and running a store in a food desert is not a walk in the park. As all three locations discovered, the store must be more than just a grocery store if it is to succeed, and that means commitment, nurturing, and a lot of listening.

Toledo, Ohio: A hospital opens a grocery store

In 2010 staff at Promedica health system in Toledo, Ohio, had begun to look more broadly at the social determinants of health among their patients and believed a full-service grocery store in the UpTown neighborhood could help spur better health. They approached local and national grocery chains and offered to be a partner by providing health education at the store. The chains politely declined. “It’s not our business model,” they said.

“That was a gut check,” said Kate Sommerfeld, who heads the Social Determinants of Health Institute at Promedica. The health system realized it might need to do this on its own.

Large supermarket chains are often quick to pass on low-income neighborhoods because they presume (often falsely) that there’s little value or spending power there. Yet as research has shown, if the analysts just looked a little harder, they’d find ample spending power. A recent analysis of Mastercard credit card data (made anonymous) in a historically Black neighborhood in New Orleans found that following several community development projects, growth in consumer spending was 12 times greater than the city as a whole.

In Toledo, the national grocery chain may have declined, but Promedica’s CEO was determined to push ahead despite the odds, said Sommerfeld.

So a hospital went into the grocery business.

Today the 6,500-square-foot Market on Green, which is owned and operated by ProMedica, is part of a much larger $50 million community investment as part of the ProMedica Ebeid Neighborhood Promise for place-based investments.

The hospital has learned many lessons in operating a grocery store, among them to be humble and pivot when things aren’t working out.

“It’s been a steep learning curve,” Sommerfeld said. “We build hospitals not grocery stores.”

The key, she said, is to engage many partners. The lightbulb has clicked on among hospitals that investing in neighborhoods is a good thing to do, but that doesn’t mean healthcare systems have to reinvent the wheel.

Promedica Ebied Institute with Market on Green on the ground floor.  (Photo by Promedica; courtesy Build Healthy Places Network)

“Others have been doing this for decades,” Sommerfeld said. “There’s strength in partnering with people who have been doing this.”

The biggest lesson, though is that while food is important you need a holistic, intentional investment if you want to succeed. In this case, the project includes affordable housing, a financial coaching program, and a job training program.

Their efforts are paying off. A medical prescription from Promedica clinicians for free, healthy food for patients identified as at risk for food insecurity has led to a 15 percent reduction per person in health care costs. The grocery store’s impact will take longer, but said Sommerfeld, “we’re on the right path.”

Richmond, Virginia: Listening to the community

In East Richmond, Virginia, no national grocery chain had located in the Church Hill neighborhood for decades. It was too challenging when two-thirds of the neighborhood residents lived in poverty, the chains argued. It would require the stores to be far more engaged in the community than their business model allowed.

Long-time food bank operator Norm Gold, however, thought it could work when local philanthropists Steve and Katie Markel approached him about opening a new store in Church Hill, especially since they envisioned more than just a stand-alone store.

Like in Toledo, the $6 million grocery store, the Market@25th, is part of a larger $40 million development that includes a Virginia Commonwealth University-sponsored health hub, 54 affordable apartments, a Boys and Girls Club, and the Kitchens at Reynolds, a culinary school housed at the nearby community college.

The store itself is designed to foster belonging and a sense of place. It promotes minority-owned businesses, from Joyebells Sweet Potato Pies to Gimme Pound pound cakes, as well as a local butcher and florist. The aisles and departments reflect the history of the community, named as they are after schools, local churches, and more. To help with transportation issues, the store also partners with Lyft and a local van service to provide subsidized rides to and from the store.

Gold worked with local residents and a historian to create a timeline of the neighborhood dating back to the 1800s. “It doesn’t hide anything,” said Gold. “One gentleman who was pivotal in its design stood in tears looking at it. It both made him proud and hurt for his community.” They also hire locally, including an in-depth course in life skills and job-readiness training, which Gold said has helped several employees gain financial stability. To date, they’ve trained 50–60 residents, including the formerly incarcerated and homeless neighbors.

But it took a lot of listening to get to where they are today. Many residents didn’t believe the sincerity of Steve Markel and other white developers to follow through on the promises. Even after they opened, many residents felt the store was too nice for them.

“Many in the community still aren’t used to thinking they should deserve that kind of store,” said Markel, who followed the advice of renowned community leader Bill Strickland in Pittsburgh to build with the same quality as if you were building for a wealthy neighborhood. Building trust was hard, Gold added, but it is starting to develop.

Sheryl Garland, chief of health impact for VCU Health System, which, along with the university, jointly funds and operates the VCU Health Hub @ 25th next door to the grocery store, also stressed the importance of listening to and learning from residents.

“We want to make sure the Health Hub is beneficial for the community residents, and not just say it but show it,” she said. “Our stance is, if there was ever a place where we need to be engaging in a different and more intentional way with communities, this is the place.”

The grocery store and Health Hub work in tandem to promote a holistic view of health and well-being, and that means creating more than a storefront, said Natalie Pennywell, director of the Health Hub. A mother with diabetes, for example, may be struggling with her diet, so program staff might help her select healthy foods in the grocery store that fit her budget. Program staff might suggest a cooking class in the grocery store or with a community partner to help her discover new recipes. And they might connect her to a community health worker housed in the Health Hub to track her progress and support her through both success and any setbacks.

Lyft Lounge in Market@25th. (Photo by Kristen Rabourdin; courtesy Build Healthy Places Network)

“You can’t just can’t plop a grocery store in a food desert and expect people to change behavior,” said Pennywell. “You need a more comprehensive approach.”

The grocery store has been up and running since spring 2019 and the Health Hub has been operational for about a year. It hasn’t always been smooth sailing, says Markel, who began the project with the hopes of better understanding community poverty and how to alleviate it.

“It’s been such a long road, it’s hard to describe,” he said. “There’s no simple solutions. I wanted a deeper and better understanding of the problems, that’s why I got involved. I was optimistic I’d find better solutions. That hasn’t happened. It’s only gotten more complicated. At the end of the day, it’s about poverty and wealth. Putting in a grocery store and a larger development doesn’t solve all the problems. But I hope and believe it’s a step in the right direction.”

But if research proves right, it is these small steps that lead to other investments, and with them a sense among neighbors that they are indeed “worth it.”

Those ripple effects might be cropping up already. A 10,000 square foot Planned Parenthood and women’s health center recently opened its doors, and a several nonprofits and the Maggie Walker Land Trust have recently moved into a nearby renovated building. The Boys and Girls Club also acquired a block of land and is building a teen center.

The store’s first anniversary coincided with the COVID-19 crisis, so there wasn’t much celebrating, though Gold says the pandemic has helped to solidify for residents the importance of a local store.

“Trust is a hard thing to earn when there’s been so much in the community that developed the distrust,” he said. “But it’s coming back.”

South Atlanta: Above and beyond

Each week, Jeff Delp gets in his van and drives about 100 miles to Opelika, Alabama, to pick up Carver Market’s wholesale order from long-time grocer Jimmy Wright. The two met by chance in Atlanta as Delp was getting Carver Market off the ground. Delp’s day job is director of economic development at Focused Community Strategies, the nonprofit community development organization managing the market.

Wright knew what Carver Market was up against as a small store with limited revenue. Large wholesalers aren’t interested in small stores and corner store distributors want to see more liquor and cigarette sales.

“As a nation, we’ve sold out to the supermarket model,” Wright said, referring to buying power the large stores have over small ones. “Our commitment to that model is the problem, not that neighborhoods can’t support a store,” he said.

So he offered Carver Market the golden ticket — access to his own wholesale distributor. “We worked a deal where they order through me from my supplier and they come and pick it up.”

Despite the drive, Delp jumped at the offer because it meant that the market could keep its prices low while still offering a wide range of fresh produce and other healthy products, because as we know, in America it’s cheaper to eat badly than to eat well.

The arrangement is telling though, he said.

“It blows my mind that here’s Carver Market in a large regional hub like Atlanta and we have to go to a small town in Alabama to get groceries.”

The store opened in 2015 in a neighborhood whose nearest full-service store was a three-transfer bus ride away. Though still not turning a profit, today the 3,500 square foot market works hard to create a welcoming atmosphere for all shoppers. “That goes a long way to softening the mistrust,” Delp said.

The jobs the market provides are also “launching lives,” Delp added, and the market is giving neighborhood residents that all important sense of hope and positivity. And they are doing it without gentrification’s displacement, Delp stressed. After nearly 20 years of concerted effort in community rebuilding, “We’re getting closer to what we hoped for: a solid, diverse mixed-income community where different walks of life want to be here, and can afford to stay here.”

If you can’t beat ‘em…

Although these three grocery stores are beating the odds, their stories reveal the herculean work and commitment it takes to succeed. Plenty of entrepreneurs would be happy to run a small market if they could get their hands on the goods at an affordable price, if they could find the perfect mix of price and profit, if they could overcome the deep distrust in the community after years of disappointment.

All those roadblocks are one reason the Healthy Corner Store Initiative by the Food Trust has decided that if you can’t beat ’em, improve ‘em.

Although liquor and cigarettes are corner stores’ prime money makers — and the items their distributors push — as the Corner Store Initiative has discovered, the bodega owners are happy to shift to healthier options with a little guidance and support.

“Most are really dedicated to introducing and maintaining healthy products,” said Juan Vila, senior program manager at the Initiative.

The Initiative provides that support, from offering free coolers and shelving plus ongoing coaching in exchange for a guarantee that the owner will provide healthy items. They start small, asking owners to provide just eight healthy items in the store.

A corner store might start by adding a small produce stand near the cash register and learn how to display the produce to make it appealing. They may then graduate to a refrigerator with a mix of juices, yoghurts, and kid-friendly items. Gradually, the owners add their own healthy products based on their customers’ needs.

At first, Vila said, many shop owners are skeptical. They don’t think their customers are looking for healthy items, but once they see the demand — and profits — they’re on board.

The program has been such a success that in San Jose, where Vila’s located, several mom-and-pops have completely stopped selling cigarettes.

Snickers bars are not going away, he said, but when healthy items are more prevalent, shoppers will buy them. An early evaluation of the program’s impact showed a 60 percent increase in fresh produce sales across all the stores in the program. And many, said Vila, have seen even higher increases.

Food Apartheid

Today, more than half of all low-income ZIP codes across the U.S. fit the definition of food deserts — areas empty of good-quality, affordable fresh food. Karen Washington, founder of Black Urban Growers, thinks of the phenomenon not as food deserts but as food apartheid, she told the Guardian, a deliberately designed system whose root cause starts with inequity. She may have a point. But step by step, these grocery stores and bodegas profiled here are beginning to chip away at that insidious form of apartheid.

This story was co-published with the Build Healthy Places Network. Read it on their site here.

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Barbara Ray has nearly 30 years of academic publishing and policy writing experience.

Tags: healthcarefood accesspublic healthsocial determinants of health

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