A Challenge in the Baltimore Food System

Introduction

There are challenges present in city food systems across the United States, based on many factors such as local, state, and federal policies, population demographics, and city infrastructure. The city of Baltimore is no exception, possessing a host of its own unique challenges. One significant challenge the city faces is the lack of availability of healthy food in corner stores, which are the most prevalent and accessible food retail outlet in the city. To address this problem, we propose a program that will be offered as an additional incentive for corner store owners participating in the Baltimarket program. The incentive will link corner store owners with local farmers, simultaneously reducing food waste and providing Baltimore city residents with low-cost healthy food via corner store outlets. This paper further describes the challenge of lack of healthy food in corner stores and outlines a proposal for the program connecting corner store outlets with food producers based on the following criteria: effectiveness, cost, feasibility and sustainability, ethical acceptability, and level of social and political will.

Challenge

Despite the many interventions that have been implemented to improve the Baltimore food system, there are still gaps that exist. One major gap can be observed in the Baltimore Food Environment Report’s measure of the Healthy Food Availability Index (HFAI) in different food retail establishments throughout the city. This indicator measures quantity and variety of staple food groups and healthy options in stores, assigning each establishment a score ranging from 0 to 28.5. The score is based on the presence of a market basket of staple foods and whether healthy options of common foods are available. The report applies the HFAI to four primary food retail environments in the city: small grocery and corner stores, convenience stores, public markets, and supermarkets. Out of these environments, small grocery and corner stores had the lowest average Healthy Food Availability score at a value of 9.1. There are at least 525 small corner and grocery stores located throughout the city compared to 183 convenience stores, 6 public markets, and 47 supermarkets, making corner stores by far the most widespread type of food retail environment (BFPI, 2018).

It is problematic that one of the most prevalent sources of food in the city significantly lacks healthy options. While levels of access to corner stores may be high for residents across the city, access to healthy foods within these stores is low. Through qualitative interviews with Baltimore corner store owners, researchers found that corner store owners often were hesitant to stock healthy products due to perceived high costs of healthy food items (Ross et al, 2017). The problem of high prevalence of corner stores with limited healthy options also presents a social justice issue, as low-income urban residents are less likely to have access to food retail environments with higher HFAI scores (Song et al., 2009). Some researchers found specifically that “small and medium-sized food stores and carry-out restaurants are the predominant food sources, particularly in lower income neighborhoods” (Gittelsohn et al, 2008). This lack of access limits a specific subgroup of residents’ food choices to products sold in corner stores, diminishing both their agency and opportunities to maintain their health.

Intervention

To attempt to remedy this problem in the food system, I propose that a program should implemented to expand the Baltimarket Healthy Stores program that is already in place in Baltimore city. The Baltimarket initiative is a joint program run by the Baltimore County Health Department, Maryland Community Health Resources Commission, Johns Hopkins Bloomberg School of Public Health, the YMCA, and Baltimore City Public Schools with the goal of reducing childhood obesity through improvement of food retail environments, including corner stores (BCHD, 2014). The three major components of the Baltimarket program are improving healthy food selections in corner stores, designating youth neighborhood food advocates to facilitate conversations around healthy eating, and providing grocery store-based nutrition education. The program currently provides several incentives for storeowners who commit to stocking healthy food products, including technical assistance, customer education, marketing, start-up incentives and infrastructure. As of 2017, Baltimarket has attracted approximately 17 corner store locations to carry out the initiative (Rock, 2017). (The program received a grant in 2017 to help expand partners by 40 stores, but updated figures are not yet available.) The few participating stores are also densely concentrated within a radius of a few blocks, serving a limited number of Baltimore city residents. It is hoped that by adding another offered incentive for corner store owners, the Baltimarket initiative will be able to attract more corner store participants and produce a greater positive impact on the health of Baltimore city residents.

The expansion of the Baltimarket program would offer an additional nonfinancial incentive from the Baltimore City Health Department for corner store owners who attempt to increase healthy options and decrease unhealthy options in their stores. The new incentive will consist of forming partnerships between corner store owners and local farmers. The farmers will directly supply fresh produce that they would not be able to sell otherwise to corner store owners at a discounted rate so that the stores can provide healthy food choices for their customers. It is hoped that this incentive will not only positively influence corner store consumers’ healthy food choices, but enhance corner stores’ and farmers’ sales overall.

Effectiveness

Effectiveness can be defined as success in achieving the intervention’s goal. The incentive linking corner store owners to healthy food suppliers is modeled after a component of the successful Healthy Corner Store Initiative implemented in the city of Philadelphia, where The Food Trust nonprofit group, Philadelphia Department of Public Health, Pennsylvania Department of Community and Economic Development, Representative Dwight Evans, the Philadelphia Department of Commerce, the AstraZeneca HealthCare Foundation and the Jefferson Center for Urban Health have collaborated to support corner store owners in stocking healthy food items (The Food Trust, 2014). The program is very similar in terms of content and partners to Baltimarket, but has managed to enroll over 600 corner stores across the city of Philadelphia compared to Baltimore’s approximate 17. The Healthy Corner Store Initiative simply offers an example of an expanded version of Baltimore’s Baltimarket program. Evidenced by the hundreds of corner stores enrolled in Philadelphia’s program, it has been successful in attracting partners to carry out its mission to assist city residents in choosing healthier foods. While Philadelphia holds nearly twice the population of Baltimore, it is a very similar city in many regards, located only 100 miles away on the east coast with similar population characteristics such as racial makeup and percent of the population in poverty (US Census Bureau, 2017). In addition to similar population composition, residents in both cities seem to rely heavily on corner stores for sustenance. Baltimarket and the Healthy Corner Store Initiative already share many similarities, such as empowering youth to be agents of change, providing technical assistance to store owners, marketing healthy messages, and contributing store-based nutrition education. These resemblances suggest that the additional program linking corner store owners to local farmers employed in Philadelphia may be effective in achieving the same goals in Baltimore.

Cost

Cost can be defined as the amount of money required to implement the intervention. It is anticipated that the cost of linking corner store owners to local farmers and fresh food suppliers for the Baltimore City Health Department would largely be associated with staff time. However, costs could be saved in the long run if the city’s disease burden and level of food waste are diminished. Food waste is a huge problem in the United States; with researchers estimating that 40% of food is wasted per year (Baltimore Office of Sustainability, 2018). The 2016 Rethink Food Waste Through Economics and Data (ReFED) report considers the issue of food waste from the standpoint of the producer, stating that 20.2 billion pounds of farm-raised fruit and vegetable crops grown in the United States every year fails to reach the consumer market (ReFED, 2016). Much of this produce is perfectly healthy to eat, but may not meet supermarket standards due to abnormal appearance or overproduction of crops. The report specifically recommends that farmers should “collaborate with food businesses to further develop a secondary market for imperfect produce,” and grocery retailers should “boost revenues by marketing discounted imperfect produce” (ReFED, 2016). Baltimore corner stores could serve as effective grocery retailers to partner with farmers to carry out these recommendations, benefitting the store owner, the farmer, and the consumer. Corner stores would be able to obtain surplus or malformed produce directly from producers at a rate lower than the standard market price, farmers would be able to increase their profits by selling produce they would have otherwise had to discard, and consumers would be able to more easily access healthy food via the corner stores.

A staff member at the Baltimore City Health Department could be assigned to identifying farmers and corner stores willing to participate in the program and incorporating this into their workload. If necessary, an additional staff member could be hired with this task as their primary responsibility, or a committee could be formed in order to divide up the tasks. In 2017, the Baltimore City Health Department received a $150,000 grant from the Maryland Community Health Resources Commission to support the Baltimarket program, including expanding the number of corner store partners by 40 stores over two years (Rock, 2017). Because the proposed incentive and grant share the common goal of expanding the number of Baltimarket’s corner store partners, some of these funds could potentially be used to finance staff time. If these funds have been exhausted, the Baltimore City Health Department could apply for an additional grant from another agency or foundation, citing the success of the initiative in Philadelphia or potential for reduction of food waste as a justification for funding.

Feasibility and sustainability

Feasibility can be defined as ease of implementation and sustainability can be defined as length of effective implementation. Linking Baltimore corner store owners to producers of healthy food would be both feasible and sustainable. The Baltimarket initiative has carried out substantial programming and garnered support from several partners and considerable funding since its inception in 2014. The proposed incentive has the benefit of this strong infrastructure and can build on what has already been accomplished in the city. In terms of feasibility, it is anticipated that both corner store owners and farmers will be willing and ready to participate in this program, as they both have the opportunity to derive financial benefits through increased product sales. If successful, this reciprocal partnership could also influence sustainability, as both parties will likely wish to continue their increased sales. Philadelphia’s Healthy Corner Store Initiative can also be used as a model for sustainability, as it has continued to achieve its goal of stocking corner stores with healthy items and expand its scope throughout the city since it was first developed in 2004.

Ethical acceptability

Ethical acceptability can be defined as the moral appropriateness of the intervention, including freedom for all parties involved to take autonomous actions. In terms of ethical acceptability, corner store owners and farmers will not be required to participate in the program and are free to choose depending on if it appeals to them or not. The voluntary nature of the incentive prevents either party from engaging in activities they do not believe will benefit them or their customers. If farmers and corner stores choose to participate in the program, food choices—both healthy and unhealthy—within the corner stores will also still be available to the customer, maintaining ethical sales practices. One could argue that the current sales practices in corner stores are actually unethical due to the absence of healthy choices. Based on this standard, providing healthy choices in corner stores would actually increase a store’s ethics by offering food choices that promote the health of the consumer in addition to food choices that do not. Participating in the program would also increase the social and environmental responsibility of farmers and storeowners through increasing residents’ health and minimizing food waste, which could be seen as a moral action.

Level of social and political will

Level of social and political will can be defined as eagerness of corner store owners, farmers, and government agencies to implement the program. As mentioned before, there will likely be a high level of social will amongst corner store owners and farmers due to the potential to increase product sales for both parties. There is also a high level of political will in the city of Baltimore to develop and improve initiatives surrounding the health of city residents, especially with respect to food and nutrition. This is evidenced by the Baltimore City Health Department’s many food access-related programs, which include the Baltimarket initiative, the Virtual Supermarket program, Healthy Stores program, Food Justice Forum, and Baltimore Food Policy Initiative (BCHD, 2019). The department has also released multiple food access-related publications, including Mapping the Food Environment and Food Environment Briefs for the city, council, and state legislative district. This wide array of programs and research signifies the Baltimore City Health Department’s commitment to improving the city’s health status through food access. The department will likely be willing and able to incorporate an additional initiative such as the one proposed if it has the potential to supply inexpensive, healthy food to city residents.

Conclusion

To begin implementation of the program linking corner store owners to local farmers to supply healthy produce, the Baltimore City Health Department should first identify the funding necessary for a staff member or a committee to take on the project. Once the appropriate funds have been secured, this individual or committee should begin researching local farms and the crops that they grow, and then proceed by reaching out to farmers and corner store owners to gauge interest in the program. The health department can then propose partnerships between interested farmers and corner store owners based on availability of specific products and location of each establishment. It is important to properly communicate the potential benefits of participating for each party involved. Once partnerships are formed, the health department can facilitate communication amongst parties to help arrange orders and deliveries, as well as survey corner stores to see what healthy products are being sold at what rates. Increased percentage of sales coming from healthy produce in a given corner store can serve as a metric of a successful intervention.

This intervention, either on its own or nested in a larger program like Baltimarket, could be successful in cities other than Baltimore. The Food Trust, the nonprofit organization that started the Healthy Corner Store Initiative in Philadelphia, has already successfully expanded their programs to multiple cities in Pennsylvania and the neighboring state of New Jersey (The Food Trust, 2019). Apart from an organizing body, the intervention only requires the cooperation of farmers and store owners. Both agriculture and small food retail establishments are heavily present throughout the country, so the intervention is highly possible to implement across the country. Selling surplus and malformed produce in small, accessible food retail establishments such as corner stores has the potential to increase profits for producers and retailers and positively influence the health of the consumers who shop at them.

References

1. BFPI. (2018) Baltimore City 2018 Food Environment Brief. https://planning.baltimorecity.gov/sites/default/files/City%20Map%20Brief%20011218.pdf
2. Ross A, Krishnan N, Ruggiero C, Kerrigan D, Gittelsohn J. (2017) A mixed methods assessment of the barriers and readiness for meeting the SNAP depth of stock requirements in Baltimore’s small food stores. Ecol Food Nutr. 57(2):94-108. doi:10.1080/03670244.2017.1416362
3. Song H-J, Gittelsohn J, Kim M, Suratkar S, Sharma S, Anliker J. (2009) A corner store intervention in a low-income community is associated with increased availability and sales of some healthy foods. :1-8. doi:10.1017/S1368980009005242
4. Gittelsohn J, Franceschini MCT, Rasooly IR, et al. (2008) Understanding the Food Environment in a Low-Income Urban Setting: Implications for Food Store Interventions. J Hunger Environ Nutr. 2(2-3):33-50. doi:10.1080/19320240801891438
5. Baltimore City Health Department. (2014) Baltimarket Healthy Stores Program. https://health.maryland.gov/mchrc/documents/Baltimarket-overview-Grant14-019.pdf
6. Rock, M. (2017) Baltimore City Health Department Announces New Funding to Improve Healthy Food Access. https://health.baltimorecity.gov/news/press-releases/2017-07-19-baltimore-city-health-department-announces-new-funding-improve
7. The Food Trust. (2014) Healthy Corner Store Initiative Overview. http://thefoodtrust.org/uploads/media_items/healthy-corner-store-overview.original.pdf
8. U.S. Census Bureau. (2017) QuickFacts: Philadelphia, Pennsylvania. https://www.census.gov/quickfacts/philadelphiacitypennsylvania
9. U.S. Census Bureau. (2017) QuickFacts: Baltimore, Maryland. https://www.census.gov/quickfacts/fact/table/baltimorecitymaryland,US/PST045217
10. Baltimore Office of Sustainability. (2018) Baltimore Food Waste & Recovery Strategy.
11. ReFED. (2016) A Roadmap to Reduce U.S. Food Waste by 20 Percent. https://www.refed.com/downloads/ReFED_Report_2016.pdf
12. BCHD. (2019) Chronic Disease Prevention: Food Access. https://health.baltimorecity.gov/programs/food-access

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