Healthy Convenience Store Initiative

State: NY Type: Model Practice Year: 2012

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The Healthy Convenience Store Initiative is sponsored by the Albany County Strategic Alliance for Health (ACSAH), a chronic disease prevention program funded by the Centers for Disease Control and Prevention (CDC) and coordinated by the Albany County Department of Health. Our goal is to enable communities to reduce the burden of chronic disease through sustainable, evidence-based chronic disease prevention and health promotion programs that focus on policy, systems, and environmental change. Our focus area is the City of Albany’s South End, West Hill, Arbor Hill, and North Albany neighborhoods (zip codes 12202, 12204, 12206, 12207, 12210) with a high incidence of chronic disease. In 2010, the Albany County population was 304,204 and the City of Albany was 97,856. The target population for the Healthy Convenience Store Initiative (HCSI) is low-income residents of urban neighborhoods who are underserved by produce retail options near their homes.

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Albany County Department of Health
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Healthy Convenience Store Initiative
The Healthy Convenience Store Initiative is sponsored by the Albany County Strategic Alliance for Health (ACSAH), a chronic disease prevention program funded by the Centers for Disease Control and Prevention (CDC) and coordinated by the Albany County Department of Health. Our goal is to enable communities to reduce the burden of chronic disease through sustainable, evidence-based chronic disease prevention and health promotion programs that focus on policy, systems, and environmental change. Our focus area is the City of Albany’s South End, West Hill, Arbor Hill, and North Albany neighborhoods (zip codes 12202, 12204, 12206, 12207, 12210) with a high incidence of chronic disease. In 2010, the Albany County population was 304,204 and the City of Albany was 97,856. The target population for the Healthy Convenience Store Initiative (HCSI) is low-income residents of urban neighborhoods who are underserved by produce retail options near their homes. Some City of Albany neighborhoods are food deserts where customers are habitually left with few options but to buy less expensive, less nutritious, high calorie, and more heavily processed foods to satisfy their daily caloric needs. Food availability is a larger issue as the lack of accessible and affordable healthy food undoubtedly contributes to the chronic disease burden in our communities as well. The rate of overweight and obesity in Albany County is 63% (compared to New York State at 59%) and only 24% of Albany County adults eat five or more fruits or vegetables per day (compared to New York State at 27%). (NYSDOH BRFSS, 2009.) The HCSI, a partnership of ACSAH and Capital District Community Gardens (CDCG), is a strategy to provide the community with sustainable healthier and affordable food options in neighborhood convenient stores. CDCG conducted extensive outreach in targeted areas of the City of Albany to identify potential corner stores to participate. The HCSI supplies local stores with fresh produce to stock in a customized display. During the growing season, a large percentage of produce is purchased from local agricultural producers. Through compact in-store displays, site specific marketing, and twice-weekly stocking and rotation of produce, the HCSI is increasing the availability of local and culturally appropriate produce, making it easier for families to include fruits and vegetables in their diets. The first produce unit was installed in February 2011. Prior to the installation, the owners signed an agreement which ensured: the produce unit would be prominently placed in the front of their store, used exclusively for fresh produce, retail prices would be set by CDCG, and marketing materials provided by CDCG would be prominently displayed. This program is designed to make healthy food sales profitable and thereby sustainable for convenience store owners. Store owners pay wholesale price for produce and are allowed to charge a nominal increase for resale and profit. The ultimate goal is to empower disadvantaged populations to make better purchasing decisions that level the nutritional disparities that exist between low-income and higher-income families, as well as racial minorities and majorities, and decrease the statistically imbalanced rates of obesity, diabetes and cardiovascular disease in Albany County. Marketing by CDCG includes a custom poster prominently hung in the store window, a sandwich board placed on the sidewalk in front of the store and neighborhood promotion. Between February and September 2011, CDCG installed units at five convenience stores in identified food deserts. During that period almost $10,000 in fresh produce (8,464 pounds) was purchased through these stores. ACSAH continues, with CDCG, to add new stores to the Initiative. Though no additional data is available at this time because the HCSI is a new initiative, in the future we hope to calculate the number or percentage of our target population that we are able to reach with the Healthy Convenience Store Initiative. The HCSI has been a success on many levels. CDCG has a solid reputation and long history of working in our community and understands the issues related to dealing with fresh produce that most small independent store owners are not attuned to. They provide expertise, a delivery system and pricing structure that works for the stores and for the customers. CDCG supports the program with a strong marketing effort to let the community know that fresh produce is now available. Additionally, monthly reports document that store owners are pleased with the produce sales and increased traffic into their stores as a result of stocking and promoting the availability of fresh produce. Families in the neighborhoods are grateful to have access to healthy food for their families at an affordable price.
Health Issues The Healthy Convenience Store Initiative addresses the need for more affordable and healthier produce options in urban minority communities.Typically, driving factors behind obesity, diabetes and cardiovascular disease include both a lack of physical activity and poor nutrition. The particular geographic focus area was chosen based on an analysis of chronic disease (diabetes, heart disease, and obesity), minority health disparities, socioeconomic indicators, and an assessment of the availability of resources that contribute to a healthy lifestyle. CHANGE (Community Health Assessment and Group Evaluation, a CDC tool) assessments of the community documented an absence of supermarkets; low consumption of fresh fruits and vegetables; and dependence of families on convenience stores for food purchases. In addition, according to the USDA Food Desert Location, 11,500 households in Albany County reside in food deserts. This means that residents of this County (specifically of the City of Albany) have both high rates of nutrition-related chronic disease and limited access to healthy food. More specifically, a survey of food retail stores and farmers’ markets in inner city Albany determined that weight-adjusted density (per 10,000 residents) of fruit and vegetable stores was 4.6 in the City of Albany’s minority neighborhood and 11.4 in the City of Albany’s racially mixed neighborhood. The study recommended public health interventions in urban minority neighborhoods to aid in the mitigation of these disparities. The Healthy Convenience Store Initiative supplies convenience stores with fresh produce to stock in a customized display with Capital District Community Gardens and Albany County Strategic Alliance for Health branding. Through compact in-store displays, site specific marketing, and twice-weekly stocking and rotation of produce, the Healthy Convenience Store Initiative is increasing the availability of healthy and culturally appropriate produce, making it easier for families to include produce in their diets. The cost of the produce is also kept low for both the business owner and customer through start-up funding from the ACSAH. This ensures that businesses can make a profit while families can gain access to affordable, high-quality food. Innovation Centers for Disease Control and Prevention’s Community Guide (Recommended Community Strategies and Measurements to Prevent Obesity in the United States) cites access to affordable healthy food options as a health promotion and prevention strategy: “Local government offers at least one incentive to new and/or existing food retailers to offer healthier food and beverage choices… in underserved areas.” The Albany County Strategic Alliance for Health partnered with Capital District Community Gardens (CDCG), an existing community agency with the means and knowledge to deliver fresh produce, to develop the Healthy Convenience Store Initiative. CDCG operates community gardens and also runs a successful mobile produce delivery program (Veggie Mobile) in the Capital District community. Using a combination of wholesale and local produce, CDCG is able to offer the underserved urban community fresh fruits and vegetables at an affordable price. When a store signs on to the HCSI, they are offered free delivery of produce and culling of expired produce for a limited time. In addition, store owners receive a free display unit, pay the same wholesale price CDCG pays for produce, and are allowed to retain the profit from nominal mark ups on produce. The Healthy Convenience Store Initiative is an innovative use of existing convenience stores (and communities purchase patterns) to build fresh produce capacity in food deserts. Unlike food markets, HCSI allows for establishment of fresh produce hubs for a modest startup expense. Furthermore, HCDI directly complements and integrates with companion means of nutrition delivery (i.e. community gardens, mobile markets). There is no single definition of what constitutes a healthy corner store project, but they all share a common goal: working with small business owners to make healthier choices easily available in underserved communities. The efforts reflect any of a number of approaches: Conducting full-scale “corner store conversions,” in which corner stores make infrastructure changes (such as acquiring refrigeration units) to sell fruits and vegetables; Improving the nutritional profile of foods currently offered; Creating new or tapping into existing distribution networks to make locally grown/organic produce available in corner stores; Implementing social marketing tactics in the store and its surroundings to promote healthy choices available in the stores. The ACSAH did not find a template for implementing a corner store initiative. Instead, through a literature review and issuance of a Request for Proposals, the ACSAH and Capital District Community Gardens (awarded agency) designed all elements of the Healthy Convenience Store Initiative. REFERENCES/ SUPPORTING EVIDENCE/ LITERATURE REVIEW a. Food Trust http://www.thefoodtrust.org/php/programs/corner.store.campaign.php b. Planning for Healthy Places http://www.phlpnet.org/php/products/healthycorner-Stores c. Healthy Corner Stores Network www.healthycornerstores.org d. “Assessing Retail Fruit and Vegetable Availability in Urban and Rural Underserved Communities,” Preventing Chronic Disease Public Health Research, Practice and Policy ; Vol 5: No. 4 (October 2008) http://www.cdc.gov/pcd/issues/2008/oct/07_0169.htm e. “Access to Healthy Foods in Low-Income Neighborhoods Opportunities for Public Policy”, Rudd Report, Yale University; Fall 2008. f. Delridge Healthy Corner Store Project, http://healthycornerstores.org/wpcontent/uploads/resources/Delridge_HCS_Toolkit.pdf f. “Snacking in Children: The Role of Urban Corner Stores,” Borradaile, et. al; Pediatrics 2009; v.124; 1293-1298 Unlike farmers’ markets and community gardens, the Healthy Convenience Store Initiative stores can offer fresh produce year-round and at an affordable price. In addition, rather than offer incentives to large grocery chains to establish stores in urban areas, the HCSI enables small business owners, an existing resource in the community, to provide more nutritious and culturally appropriate produce for their neighborhoods. The Healthy Convenience Store Initiative is expanding upon the work that Capital District Community Gardens is doing in our Region to provide greater access to affordable fresh produce in our inner-city neighborhoods. Since 2007, CDCG has been operating a mobile produce market (The Veggie Mobile) in urban food deserts in our region. The Veggie Mobile provides weekly service to 23 locations throughout our Region. The produce is sold at wholesale cost – which is about half the cost of local supermarkets, if residents had a market nearby. The Initiative is augmenting this food access in the same neighborhoods by providing an opportunity to purchase produce seven-days-a-week.  
Primary Stakeholders Albany County Strategic Alliance for Health Albany County Department of Health Capital District Community Gardens local convenience store owners Role of Stakeholders/Partners The ACSAH awarded Capital District Community Gardens (CDCG) a sub-contract to implement the Healthy Convenience Store Initiative. Thus, CDCG outlined the design, implementation, and sustainability strategies for the HCSI. The HCSI would not be possible without the expertise of CDCG. Capital District Community Gardens is a non-profit community service organization that has been helping Capital District residents improve their neighborhoods through healthy food access since 1975. LHD Role The Albany County Department of Health (ACDOH) was awarded the Albany County Strategic Alliance for Health (ACSAH) grant from the CDC and is the fiscal agent. All goals, objectives, and financial decisions are determined by the ACSAH coalition. Under the direction of ACDOH as fiscal agent, the Albany County Strategic Alliance for Health is a coalition of community agencies, worksites, healthcare, schools, governmental and community based organizations. All work plan activities are coordinated by Albany County Department of Health staff with assistance from coalition partners. The Healthy Convenience Store Initiative (HCSI) was chosen by the ACSAH as a viable strategy to increase the availability and affordability of healthier food options in the City of Albany. Capital District Community Gardens is a member of the Albany County Strategic Alliance for Health. As fiscal agent, the Albany County Department of Health awarded Capital District Community Gardens the funding for the Healthy Convenience Store Initiative as a result of their response to a Request for Proposals. Lessons Learned CDCG was responsible for establishing five stores as HCSI locations in the City of Albany proximate to schools and within neighborhoods designated as food deserts. Recruiting stores required visiting potential stores to gauge appropriateness for the Initiative, speaking with store owners about the benefits of the Initiative, and ensuring that store owners signed all necessary agreements to participate. It was crucial to have a HCSI Coordinator to spearhead all activities. In addition, while store owners kept any profit from produce sales, it was imperative that they price items reasonably to maintain affordability for the community. Therefore, CDCG required that store owners sign an agreement where prices for each produce item were established. The HCSI is a demanding endeavor as each store receives new produce twice a week, the old produce needs to be culled out, and the unit needs to be properly maintained. Ideally, the store owners will ultimately take ownership over the display and decide what items need to be restocked, thus saving CDCG staff some time; time that could be used to recruit additional stores. CDCG is progressing towards a model that will put more ownership and responsibility into the hands of the store owners. Implementation Strategy CDCG surveyed the community to determine if there were convenience stores selling fresh produce, the quality and price of that produce. If stores were filling the need ACSAH did not implement its Initiative nearby so as not to compete with a store that was already selling affordable produce. CDCG then identified potential stores to work with, talked to store owners about the project and reviewed the agreement with them. Once the agreement was executed, CDCG worked with the store owner to find a highly visible location for the produce unit and window signage. The unit was installed and stocked, and a schedule was established for twice a week restocking. Data was collected and reported on a monthly basis to the Albany County Strategic Alliance for Health. CDCG spent three months creating the customized produce unit for the project and the marketing materials (signage and flyers). Two months were spent surveying the target community to determine which stores we were going to target for the Initiative. Depending upon the store location, it took between one to three months to obtain a signed agreement and install the unit in the store.  
Process & Outcome Increase access to fresh produce in inner-city convenience stores in the City of Albany. Objective 1: The performance measures used to achieve this objective include surveys done with potential stores and data tracking of amount of produce / value of produce sold in stores involved in the HCSI program. Prior to bringing the Initiative into a store, CDCG’s Project Coordinator conducted a written site survey to determine if the store had the appropriate characteristics (space for a produce unit, enough overall products for sale, adequate lighting, and minimal loitering). In addition, CDCG documented whether the store offered any produce for sale and what other healthy food options (i.e. low-fat milk, whole-grains) were available. As part of the Initiative, the amount of produce sold, dollar value of the produce and amount of produce waste for each store was tracked. Results from the initial site surveys helped CDCG determine which convenience stores had the most inviting environment for customers. CDCG was particularly concerned about any potentially inappropriate activity that might be occurring. This was determined by visiting the stores and taking note of important performance indicators. As a result of the surveys, CDCG was able to locate the Initiative in stores which were appropriate for children and families. Tracking the amount of produce sold and sales have been key indicators of the success of the project. Since installing the units, each month there has been an increase the amount of produce sold and a decrease in the amount of produce wasted. Particular outcome measures (as of September 30, 2011) include an increase in stores participating in the Initiative from zero to five; sales of fresh produce ($10,000); and pounds sold (8,464).    
Making healthy food sales profitable for convenience store owners is a practical method of achieving program goals. Marketing and products are tailored to the needs and clientele of individual stores. CDCG is also experimenting with new product development, such as sliced fruits, prepared salads and the distribution of healthy snacks (e.g. nuts, trail mixes and dried fruits). The greater success store owners experience in selling healthy foods the more likely they are to continue making them available to their customers. At first, participating stores purchase produce at CDCG’s wholesale cost, are stocked with produce free of charge, and absorb 100% of the profit from produce mark-ups for resale. This provides a demonstration period to show store owners how healthy foods and fresh produce can be profit centers for their stores. After six months, store owners are offered the opportunity to stay in the program by agreeing to pay a small weekly restocking fee that will contribute to future delivery expenses (i.e. vehicle, gas, staff time) and the overall sustainability of the program. CDCG anticipates that convenience stores will opt to remain involved given the easy profit that The Healthy Convenience Store Initiative will bring in. Word of the Initiative has spread to neighboring cities about the success of this effort which has resulted in store owners approaching CDCG about adding fresh produce to their sites. CDCG is now working hard to educate store owners about fresh produce so that they can take a more proactive role in the operation of the Initiative. This will be critical to the long-term success of the project and ACSAH and CDCG’s mutual ability to continue to expand into additional locations.
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