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Food in the DesertChristopher Myers

Food in the Desert (cont'd)

First, investigators quizzed Food Depot customers to explore how their limited financial resources influenced their purchases. More than 70 percent receive federal Supplemental Nutrition Assistance Program [SNAP] benefits, the formal name for food stamps. They also asked shoppers how the store's layout affected their decisions to buy nutritious items and solicited suggestions on how to promote more healthful purchases.

Just as Gittelsohn contends, the results indicated that low-income residents know healthy from unhealthy. "They have thought about it significantly," Palmer observes, "and they're making very rational choices of what's available to them."

That includes looking elsewhere for healthy food. "People cannot purchase what is not accessible," explains Joyce Smith, who works with Palmer as a community liaison coordinator in Southwest Baltimore. "[When feasible] they travel to other communities-some beyond city limits-where better supermarkets are located."

In cooperation with Green, the FCPHP team moved into intervention mode in 2012. They reduced healthful foods' prices and gave in-store tests, moved healthy choices to eye level, displayed signage encouraging the purchase of low-fat, low-sodium and low-sugar options, set up end-of-cap aisles and register racks featuring healthy grab-n-go items and suggested recipes to customers. The team also worked with store employees on how to better promote healthier food choices and collaborated with a staff dietitian hired by Green.

By the time the intervention concluded, Food Depot had been transformed. Green replaced its warehouse-like sensibility with a warmer, more inviting atmosphere, hired more staff, improved the variety of produce (adding yucca, boniato, chayote squash and tomatillos), began buying locally when possible and started making low-fat prepared foods.

"It's unique in terms of a supermarket in a low-income neighborhood," says Palmer, "both visually and display-wise."

On a recent December morning, Theodora Morris was perusing the augmented produce section, with her husband, Eugene, following attentively. She was shopping for the two of them, their three children and one grandson. "I like to shop healthfully," notes Morris, placing two bags of mini carrots in her cart. "The vegetables here are good, and they have better prices."

Barbara Countee, at the store to buy salmon, is also price conscious. "Healthy choices can be very expensive," she says. Still, she prefers fresh vegetables-"cabbage, lettuce, greens, broccoli"-to frozen ones, and she avoids the canned variety entirely.

Meanwhile, over in the store's dairy section, Teshea Jackson-shopping for herself, her daughter, her fiancé and his daughter-hauls a gallon of 1 percent milk out of a chilled case. In an effort to consume less fat, "I made the change from [whole milk] about a year ago," she relates. But like Morris and Countee, she considers price extremely important; she cuts costs by choosing canned fruit over fresh.

It's too soon to say if the two-year program made a difference. Pam Surkan, PhD, ScD, the project's principal investigator and an assistant professor in International Health, is still analyzing the data.

From a business point of view, it's "an uphill battle," says Green. "People make their own choices; we can't tell them how to act. And we can't simply stop selling the stuff that may not be very good for them-we're in business," he says. "So we have the good and the bad stuff and everything in between."

Why It's Hard To Eat Healthy

The battle against food deserts may never end, but City food policy director Freishtat thinks they can be eliminated in some areas and at least reduced in others.

For her, the most imposing obstacle to that goal resides in Washington, not Baltimore: decreasing funds for SNAP benefits. In January 2014, the House of Representatives approved a Farm Bill cutting the federal food stamp budget by $8 billion over 10 years. (Initially House leaders had sought to cut $40 billion from the SNAP budget, which had doubled in size during the national recession.) On February 4, the Senate approved the bill. President Obama signed the bill into law on February 7.

"We cannot forget that SNAP is an economic driver in our city-$422 million annually is spent on SNAP in the city and surrounding areas," says Freishtat. "Retailers are impacted by any fluctuations to the SNAP budget, as are the individual residents."

Depending on how the SNAP reductions affect people and retailers, more food deserts could appear in Baltimore and other cities.

Anticipating additional cuts in SNAP funds, Food Depot's Green expects to see shopping patterns change at his store as customers choose cheaper, unhealthful items over more expensive, healthy ones. He cites processed white bread instead of whole wheat as an example.

Palmer believes that knowledge still holds the key to reducing food deserts. "We want to provide qualitative research to the public and academia that gives a better understanding of how hard it is for people to eat healthfully," she says. "So often we want to say, 'Oh, those poor people living in those neighborhoods,' or we victimize them-we do them a disservice, as if they don't understand or haven't thought about choosing and eating healthful foods.

"We need to turn that on its head and say, 'Why do we make it so hard for people to eat healthfully?' We need to convey how difficult it is to do what we're asking people to do, and really respect that they understand their circumstances way better than we ever could. They are partners in this."

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