Financing initiatives, tax incentives, or zoning regulation changes can be structured to bring grocery stores or supermarkets to underserved neighborhoods. Grocery stores or supermarkets that sell a wide variety of fresh fruits and vegetables, dairy products, meat, baked goods, packaged, and frozen items are less available in low income than in middle income neighborhoods, in predominately black than white neighborhoods, and in urban than suburban areas (Powell 2007*).
Expected Beneficial Outcomes (Rated)
Increased access to healthy food
Other Potential Beneficial Outcomes
Increased healthy food consumption
Reduced obesity rates
Increased food security
Improved health outcomes
Evidence of Effectiveness
There is some evidence that attracting new grocery stores to underserved areas increases access to healthy food in these communities (Abeykoon 2017, Rogus 2018*, Richardson 2017*, Elbel 2015a). Such stores can improve perceptions of food access, neighborhood satisfaction, and mental health. Improved perception of access to healthy foods may raise awareness and improve decision-making about healthy foods, which over time can develop into improved health outcomes (Abeykoon 2017). Additional evidence is needed to confirm effects of attracting new grocery stores to underserved areas on healthy food consumption, overall dietary behaviors, and health outcomes, especially over the long-term (Abeykoon 2017, MacMillan 2018).
Changes to local food environments such as attracting new grocery stores can increase healthy food consumption among individuals shopping at these stores (MacMillan 2018). In a Bronx-based study, living within a half mile of a new supermarket changed residents’ purchasing and consumption behavior; residents purchased more healthy and unhealthy foods, consumed more produce and water and less sugar-sweetened beverages and pastries, and more residents reported always having produce available at home (Rogus 2018*). Other studies find no short-term changes to purchasing or consumption behavior (Elbel 2015a), suggesting that more comprehensive strategies may be needed to promote dietary behavior change (Cummins 2014, Boone-Heinonen 2011, Sadler 2013), such as reducing prices and increasing marketing of healthy foods (Ghosh-Dastidar 2014*) and improving the overall balance of healthy and unhealthy food retail in neighborhood food environments (McGuirt 2018). One study suggests that opening a new supermarket in a food desert increases access and availability of healthy foods for residents living in close proximity to the store; however, existing convenience stores may reduce healthy food offerings in response (Ghosh-Dastidar 2017*).
A Pittsburgh-based study suggests living in a neighborhood with a new supermarket is associated with improved food security, reduced SNAP participation, and reduced new diagnoses of high cholesterol and arthritis (Richardson 2017*). Greater supermarket availability has been associated with lower prevalence of obesity and overweight (Morland 2006*, Larson 2009a*, Ford 2008*). New supermarket openings have been associated with reduced body mass index (BMI) among children from families with low incomes (Zeng 2019*). Children who live far away from a grocery store appear to have higher BMIs than children living closer to a store (Carroll-Scott 2013*). One study suggests living in neighborhoods with large supermarkets is associated with reduced BMI over time among girls, but not among boys (Chen 2016c*).
Attracting new grocery stores to low income areas alone may not address nutritional disparities across socio-economic groups; educational materials and financial incentives for consumers may be needed to help change preferences for unhealthy food and support purchase of higher priced items (NBER-Handbury 2016). Supermarkets and large grocery stores can reduce the price of healthy food in food deserts, though healthy food may still be more expensive than in non-food deserts, which suggests additional price supports may be needed. Supermarkets increase the availability of both healthy and unhealthy food options and can increase temptation to overspend on non-essential items; however, stores within walking distance can also reduce transportation costs and increase budget available to spend on food purchases (Abeykoon 2017).
Impact on Disparities
Reauthorized in 2018, America’s Healthy Food Financing Initiative (HFFI) is a public-private partnership administered by Reinvestment Fund for the US Department of Agriculture (USDA). As of 2018, America’s HFFI has given over $220 million in grants and loans to 35 states to help attract grocery stores and supermarkets and improve access to healthy food in low income, underserved rural and urban communities (Reinvestment-AHFFI, US DHHS-Healthy food financing). The national HFFI is modeled on the Pennsylvania Fresh Food Financing Initiative that supported 88 projects in urban and rural areas across the state (TRF-PFFFI). Pennsylvania’s program also inspired similar programs in Arizona, Colorado, Georgia, Illinois, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, New Jersey, New York, Tennessee, and Texas (Food Trust 2011).
As of 2011, 11 states and Washington DC have enacted healthy food retail legislation; in nine cases this legislation focuses on attracting grocery stores and supermarkets to underserved areas. Seven states have introduced such legislation that either did not pass or is pending further action (CDC-State initiatives healthy food). Between 2012 and 2014, Maryland, Massachusetts, and Mississippi passed legislation to promote healthy grocery retail options, although only Maryland’s legislation included funding, and in Texas, legislation was enacted to allow land banks to sell property to a developer that plans to build healthy grocery stores on it (NCSL-Local food legislation 2016).
PolicyLink-Grocery store 2008 - PolicyLink. Grocery store attraction strategies: A resource guide for community activists and local governments. 2008.
ChangeLab-Food retail - ChangeLab Solutions. Healthy food retail.
ChangeLab-Getting to grocery - ChangeLab Solutions. Getting to grocery: Tools for attracting healthy food retail to underserved neighborhoods.
AHA-VFHK toolkits - American Heart Association (AHA), Robert Wood Johnson Foundation (RWJF). Voices for healthy kids (VFHK): Toolkits to make the healthy choice the easy choice in the places where children live, learn and play.
LHC-Rockeymoore 2014 - Rockeymoore M, Moscetti C, Fountain A. Rural Childhood Obesity Prevention Toolkit. Leadership for Healthy Communities (LHC), Center for Global Policy Solutions, Robert Wood Johnson Foundation. 2014.
US Treasury-CDFI Fund - US Department of the Treasury (US Treasury). Community development financial institutions (CDFI) fund: New markets tax credit program.
CDC DNPAO-Food access - Centers for Disease Control and Prevention (CDC), Division of Nutrition Physical Activity and Obesity (DNPAO). Nutrition: Strategies and resources: Increase access to healthy foods and beverages.
PolicyLink-HFAP map - PolicyLink, The Reinvestment Fund (TRF), The Food Trust. Healthy food access portal (HFAP): Research your community interactive map for healthy food access.
SRTSNP-Safe routes to healthy foods - Safe Routes to School National Partnership (SRTSNP). Healthy communities: Safe routes to healthy foods.
CDC-Supermarkets - Centers for Disease Control and Prevention (CDC). Retail food stores: Grocery stores and supermarkets
HFPP-Policy database - Healthy Food Policy Project (HFPP). Policy database: A curated, searchable database of healthy food policies at the local level around the United States.
Citations - Evidence
* Journal subscription may be required for access.
Abeykoon 2017 - Abeykoon AH, Engler-Stringer R, Muhajarine N. Health-related outcomes of new grocery store interventions: A systematic review. Public Health Nutrition. 2017;20(12):2236-2248.
Rogus 2018* - Rogus S, Athens J, Cantor J, Elbel B. Measuring micro-level effects of a new supermarket: Do residents within 0.5 mile have improved dietary behaviors? Journal of the Academy of Nutrition and Dietetics. 2018;118(6):1037-1046.
Richardson 2017* - Richardson AS, Ghosh-Dastidar M, Beckman R, et al. Can the introduction of a full-service supermarket in a food desert improve residents’ economic status and health? Annals of Epidemiology. 2017;27(12):771-776.
Elbel 2015a - Elbel B, Mijanovich T, Kiszko K, et al. The introduction of a supermarket via tax-credits in a low-income area: The influence on purchasing and consumption. American Journal of Health Promotion. 2017;31(1):59-66.
MacMillan 2018 - MacMillan F, George ES, Feng X, et al. Do natural experiments of changes in neighborhood built environment impact physical activity and diet? A systematic review. International Journal of Environmental Research and Public Health. 2018;15(2).
Cummins 2014 - Cummins S, Flint E, Matthews SA. New neighborhood grocery store increased awareness of food access but did not alter dietary habits or obesity. Health Affairs. 2014;33(2):283-291.
Boone-Heinonen 2011 - Boone-Heinonen J, Gordon-Larsen P, Kiefe CI, et al. Fast food restaurants and food stores: Longitudinal associations with diet in young to middle-aged adults: The CARDIA study. Archives of Internal Medicine. 2011;171(13):1162–70.
Sadler 2013 - Sadler RC, Gilliland JA, Arku G. A food retail-based intervention on food security and consumption. International Journal of Environmental Research and Public Health. 2013;10(8):3325-46.
Ghosh-Dastidar 2014* - Ghosh-Dastidar B, Cohen D, Hunter G, et al. Distance to store, food prices, and obesity in urban food deserts. American Journal of Preventive Medicine. 2014;47(5):587-595.
McGuirt 2018 - McGuirt JT, Pitts SBJ, Gustafson A. Association between spatial access to food outlets, frequency of grocery shopping, and objectively-assessed and self-reported fruit and vegetable consumption. Nutrients. 2018;10(12).
Ghosh-Dastidar 2017* - Ghosh-Dastidar M, Hunter G, Collins RL, et al. Does opening a supermarket in a food desert change the food environment? Health and Place. 2017;46:249-256.
Morland 2006* - Morland K, Diez Roux AV, Wing S. Supermarkets, other food stores, and obesity: The atherosclerosis risk in communities study. American Journal of Preventive Medicine. 2006;30(4):333-9.
Larson 2009a* - Larson NI, Story MT, Nelson MC. Neighborhood environments: Disparities in access to healthy foods in the U.S. American Journal of Preventive Medicine. 2009;36(1):74-81;e10.
Ford 2008* - Ford PB, Dzewaltowski DA. Disparities in obesity prevalence due to variation in the retail food environment: Three testable hypotheses. Nutrition Reviews. 2008;66(4):216-28.
Zeng 2019* - Zeng D, Thomsen MR, Nayga RM, Bennett JL. Supermarket access and childhood bodyweight: Evidence from store openings and closings. Economics and Human Biology. 2019;33:78-88.
Carroll-Scott 2013* - Carroll-Scott A, Gilstad-Hayden K, Rosenthal L, et al. Disentangling neighborhood contextual associations with child body mass index, diet, and physical activity: The role of built, socioeconomic, and social environments. Social Science & Medicine. 2013;95:106-14.
Chen 2016c* - Chen HJ, Wang Y. Changes in the neighborhood food store environment and children’s body mass index at peripuberty in the United States. Journal of Adolescent Health. 2016;58(1):111-118.
NBER-Handbury 2016 - Handbury J, Rahkovsky I, Schnell M. Is the focus on food deserts fruitless? Retail access and food purchases across the socioeconomic spectrum. National Bureau of Economic Research (NBER). 2016: Working Paper 21126.
Citations - Implementation Examples
* Journal subscription may be required for access.
Reinvestment-AHFFI - Reinvestment Fund, US Department of Agriculture (USDA). America’s Healthy Food Financing Initiative (AHFFI).
US DHHS-Healthy food financing - US Department of Health and Human Services (US DHHS), Administration for Children & Families (ACF). Healthy food financing initiative.
TRF-PFFFI - The Reinvestment Fund (TRF). Pennsylvania Fresh Food and Financing Initiative (FFFI).
Food Trust 2011 - The Food Trust. Harnessing the power of supermarkets to help reverse childhood obesity: Public health and supermarket experts explore grocery store marketing practices to promote healthier and lower-calorie foods. Princeton: Robert Wood Johnson Foundation (RWJF), The Food Trust; 2011.
CDC-State initiatives healthy food - National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Nutrition, Physical Activity, and Obesity (DNPAO). Initiatives supporting healthier food retail: An overview of the national landscape. Atlanta: Centers for Disease Control and Prevention (CDC); 2011.
NCSL-Local food legislation 2016 - National Conference of State Legislatures (NCSL). State legislative trends in local foods, 2012-2014: Healthy grocery retail. 2016.
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