Health in the Margins:

Access to Healthy Food and Mission-Driven Markets

 

In this episode, Tinu speaks with Ben Perkins, the Director of the Board for Wholesome Wave and Philip Sambol, Executive Director of Oasis Community Partners. Together, they discuss the impact of healthy food access, how to create mission-driven markets in low-income communities, and the importance of democratizing wellness.  

“When engaging in communities, we have to have fidelity to those communities. What does fidelity mean? It means being in an authentic relationship with the community so that whatever solution is created is a co-creation, not the old model of experts coming in, swooping in, and telling communities what they need, that ultimately the community has to be part of the solution. And that is foundational.” – Ben Perkins 

 

Timestamps

  • 02:16 Ben and Philip’s 3 aspects that make up their identities 
  • 05:07 What is a food desert 
  • 09:59 The impact of community grocery stores 
  • 12:47 What is food insecurity and how does it happen in low-income communities 
  • 16:22 How do institutions facilitate better solutions to nutrition insecurity in lower income communities 
  • 19:25 How can small grocery stores operate in a way that is beneficial to consumers and the business 
  • 27:00 Impacts of a lack of healthy food options in low-income communities 
  • 29:24 Solutions that are available, and need in the future, to alleviate food access issues

Takeaway Learnings

  1. Large grocery store chains are not profitable in certain areas, which can create a lack of access to healthy foods in these neighborhoods. To combat this, smaller grocery stores can function in these regions by being large enough to support full, fresh food access, while being small enough to be run by a local team. Grocery stores like these, including Good Food Markets, thrive by being mission driven.
  2. Poor nutrition is one of the leading causes of sickness in the United States. On top of it creating preventable health issues, it also depresses the earning power of these communities and reduces opportunities for success in educational settings.
  3. The most effective way to ensure communities embrace nutritious food, and a healthy lifestyle, is by democratizing wellness, which allows people to reclaim their autonomy and sovereignty over their own communities, bodies, and health choices through creating community ownership.
  4. Finding a solution for food access takes time and flexibility. It requires patience and a willingness to invest in a long-term model. The goal is to reduce downstream cost of health issues by investing in upstream solutions.

Actionable Tips

  1. If you are interested in introducing health education and nutritional access to a community through a grocery store, or otherwise, consider partnering with community groups to bring events and programs to meet people where they are. Social impact and financial sustainability are equally as important for nutrition access ventures. 
  2. If you are a local leader, or government official, examine neighborhoods where fresh food access may be minimal. Call in community members, local businesses, and philanthropies to support nutrition access and education. 

Resources Mentioned in the Episode

Additional Resources

About Ben Perkins and Philip Sambol

Ben Perkins is the Director of the Board for Wholesome Wave. Wholesome Wave is a nonprofit organization that combats food and nutrition insecurity across the country by partnering with local organizations to co-design culturally competent programs. 

Philip Sambol is Executive Director of Oasis Community Partners, a DC-based nonprofit dedicated to improving food access and community health. Oasis operates the Good Food Markets social enterprise grocery store chain in the DC area. Good Food Market is a mission-driven business committed to developing retail solutions that work for food desert communities, while addressing food access, economic, and health disparities. Good Food Markets is one of the organizations that Wholesome Wave has partnered with in the DC area. 

Transcript

[00:00:00] [Music] 

[00:00:06] Ben: When engaging in communities, have to have fidelity to those communities. What does fidelity mean? It means being in authentic relationship with the community so that whatever solution is created is a co-creation, not the old model of experts coming in, swooping in, and telling communities what they need, that ultimately the community has to be part of the solution. And that is foundational. 

Read More

[00:00:34] Tinu (Recorded): Hello, and welcome to Health in the Margins. Health in the Margins is a podcast that hosts conversations between experts and community members to investigate disparities and uncover solutions related to diversity and disability in healthcare.  I’m your host Tinu Abayomi-Paul. 

[00:00:56] [Music Ends] 

[00:00:56] Today we’ll be speaking with Ben Perkins and Philip Sambol. Ben is the director of the board for Wholesome Wave. Wholesome Wave combats food and nutrition insecurity across the country by partnering with local organizations to co-design culturally competent programs. Philip is the executive director of Oasis Community Partners, a Washington DC based nonprofit dedicated to improving food access and community health. Oasis operates the Good Food Markets social enterprise grocery store chain in the DC area. Good Food Markets are retail solutions for food desert communities that address food access, economic and health disparities. 

[00:01:40] Philip and Ben work and live in DC and Boston, respectively. Both these cities are taking a supply and demand approach to addressing food access and analyzing how to create sustainable solutions for future generations. Through organizational support and engaging with their communities at large, their organizations are analyzing and working together to improve the government driven and economic factors that marginalize against nutrition access in certain communities. 

[00:02:08] [Music] 

[00:02:10] Welcome to Ben Perkins and Philip Sambol! 

[00:02:16] [Music Ends] 

[00:02:16] Tinu: Thank you both for being here. Thank you so much, Ben. Thank you, Philip. Great to have you. To start out with, we all have a variety of aspects that make up who we are as a person. If you, Ben, had to distill this down into three identities, what would those identities be? And how do they relate to your work in food access? 

[00:02:39] Ben: That is a great question. I think the three identities that for me, uh, really have been instrumental in my public health career, and informing my public health career, has been being African American, descended from enslaved folks. The other one is being queer, uh, a gay man. And, the other one I think is just being curious, being a human being that always has asked uncomfortable questions about why things are the way they are. And those three things, certainly the last one, was there from the beginning. And the other two I’ve come to understand how they play out in the world. But I think they all are connected to the issue of justice at the end of the day. And why do some have, and why do some not have? So, I would think those sort of three things come to mind, in terms of that question. 

[00:03:44] Tinu: That is really great. I’m particularly interested in that last part. I think that’s a really great one because not everybody is curious. A lot of people just kind of accept the world the way it is and don’t think about, “Hey, why is that like that? How can we change that? Is there anything that we can do?” But there’s so much that we can all do as individuals, once we decide to empower ourselves. Phillip? 

[00:04:09] Philip: Thanks Tinu. It’s great to be here. I think the identities came to mind for me: one is a contrarian, like just sort of looking at the other side, even if it ends up being a dead end, but, taking that other view. Um, as a creator, someone who always tries to build something new to see what that next stage of evolution is, and try to push things there. And then as a connector of ideas and people and being connected by people and ideas. And I think those three identities, aspects of my own personality really relate to the food access work because the prevailing wisdom here is that grocery stores won’t work in food deserts. So, you have to be somewhat of a contrarian to even consider that idea, building something new and pulling all of those connections together. 

[00:05:00] Tinu: There’s the three C’s in there to make it really easy to remember. I love it. You mentioned food deserts, which is a topic that I am wild about and that I like to talk a lot about. And the concept of a food desert is a really difficult thing to explain to people who haven’t experienced that. You know, people will say, “oh, why don’t you just buy some fresh fruit?” “Okay, from where?” So, both of you, but Philip first, would you expand on the concept of a food desert and how that plays into wellness, especially in lower income neighborhoods? 

[00:05:40] Philip: Certainly. So, I think just to start the, you know, USDA definition of food deserts, uh, in the urban context is no fresh food access, full-service grocery store, within either half a mile or one mile. Um, there are other factors, transportation, household vehicle access, income, that are relevant, but essentially places in our biggest cities, all across the country, where you can’t buy fruits and vegetables, or healthy food.  

[00:06:08] And you know, the prevailing wisdom here, as I mentioned is that, grocery store won’t work in communities that don’t have one because of the economics, because of the residential density. And I think from our perspective, at Good Food Markets, we don’t necessarily disagree with that, but the average supermarket in the U.S. is 45,000 square feet. And there is a universe of store sizes below that that could work.  

[00:06:33] And so, our model has been smaller stores that are less expensive to build, more efficient to operate, that are sized to meet the demand. Being big enough to support full, fresh food access, like a traditional grocery store, but small enough to run on a local team. And, and all of that being driven by mission driven or mission-oriented partners who want to see the health outcomes. And so, I think that’s the, the core economic problem and kind of how solutions are viewed.  

[00:07:07] Ben: So first off, the thing that I often like to raise when the term food desert comes up is: food desert is a verb, not a noun. And what I’m getting at is another term that folks particularly more socially justice minded use, which is food apartheid. And the idea that it’s no accident, largely, that we see the neighborhoods that we see, uh, with a lack of access to healthy foods. And particularly I think about the phenomena of redlining, and the history of redlining, and communities, primarily BIPOC communities, that were essentially sort of identified, marked as being undesirable.  

[00:07:52] And therefore, there’s a whole cascade of things that happened as a result of being labeled undesirable that echo, reverberate, even to today. And one of those is a lack of access to things like healthy foods, because there haven’t been investments, and some argue that there have been significant disinvestment and disincentives in those neighborhoods. And so, you see what you see and it’s no accident. And that’s why you see higher rates of cardiovascular disease, all the other things that go along with the term food desert. 

[00:08:28] Tinu: Food apartheid – that is a new term for me. Philip, on your website it talks about how wellness is democratized, “democratizing wellness” was the phrase. Would you tell us more about that in terms of the role of community grocery stores and facilitating that concept?  

[00:08:44] Philip: Absolutely. So that turn of phrase was actually written by our community health manager, who worked with us for several years, started as an intern, and, worked her way up to a, a full-time position with us, and the thinking behind using that phrase of democratizing wellness really gets to what Ben was just saying, that this is about people reclaiming their autonomy, and their sovereignty over their own communities, bodies, health, choices. And that’s what Good Food Markets is striving to do.  

[00:09:19] So, I think that, you know, we’re not successful in all things and we’re not successful all the time, but putting the fresh food in the community, at an affordable price, partnering with community groups, bringing events and programs to the space, going out into the neighborhood, meeting people where they are, and talking about their food choices, and how they view food as a part of their health, and what health means to them. And then trying to build the store around those concepts while always providing healthy, fresh alternatives to what’s there, which is predominantly carry out, fast food, corner store. 

[00:09:59] Tinu: What is the impact of the community grocery store? I just noticed that, especially when I was looking at your social media, I saw a lot of community posts that weren’t directly related to the grocery store. And I wouldn’t see that from say a big grocery chain. How are you involved in the community and is that part of the whole plan with a community grocery store or did that just organically come out of the intent of the store? 

[00:10:29] Philip: I would say both. It was absolutely an intentional part of the strategy from the beginning, community engagement, at a basic level, just to let people know what Good Food Markets is, where we are, and that we exist, to solicit that feedback and have that conversation that I was just describing. And then, as things progressed, and we opened the store, and we were operating, we started to meet groups that were mission aligned, but that they’d be at urban agriculture schools, YMCA, senior centers, who were looking for opportunities to provide health education, that the grocery store was a great platform to do. And so, over time we’ve worked with over 50 organizations to present everything from like basic cooking classes, all the way up to programs that are evaluated by academic institutions. 

[00:11:21] Good Food Markets is part of a case study that’s coming up from Robert Wood Johnson Foundation later this year that looked at 10 different community-oriented grocery stores across the country, and how they were similar, how they were different, how they were doing performance-wise, in social impacts and in financial sustainability.  

[00:11:39] And the big takeaways there for me were that one: there’s no real national replicable model here. The things that are working at a local level all require some type of ongoing operating support, but that choosing the right location, engaging with the community in a real and meaningful way from the beginning, and continuing that through to action stage, providing the products that people want at a price they can afford, and having this champion. And they’re different in each place, but there was one person who was either the fundraiser, or the operator, or just a great community leader who wanted to see this happen and sustain. Those are the things that have survived.  

[00:12:20] So, I think that that really speaks to the community being the engine for success here, regardless of the structure built around it. Like we’re a nonprofit owned store, there are nonprofit stores, there are food banks that have added annex. There’s all sorts of ways to go about this, but that it’s community informed, community driven, and what we hope to get to is community owned. 

[00:12:43] Tinu: I would love to have a community owned store in my area. So, Ben, what is nutrition insecurity? First of all, how’s it come to be? Why does it need to be addressed in low-income communities? Why is it most prevalent there? 

[00:12:59] Ben: So, what I’m gonna do is tell you a little bit about how the USDA talks about it, because it’s a fairly recent term, in terms of its’ usage. And interestingly enough, the USDA recently came out with a whole statement about nutrition insecurity. And there’s sort of – think about the old school sort of Venn diagram. This concept, which I think a lot of people are familiar with, which is food security or insecurity.  

[00:13:26] And so, nutrition insecurity is kind of, if you wanna think about a subset, or within the realm of food insecurity, but the USDA says it means “consistent access, availability, and affordability, of foods and beverages that promote wellbeing, prevent disease, and if needed treat disease, particularly among racial and ethnic minority populations, lower income populations, and rural and remote populations, including tribal communities in insular areas.”  

[00:13:59] So, one of the ways I like to talk about it is: if you think about food insecurity you think about the idea of people getting enough to eat. Which is important, you know, you get enough calories to keep your engine running, but the reality is not all foods are the same. And, some have talked about foods, sort of the differentiation between foods that are energy dense, have a lot of calories, versus foods that are nutrient dense, which have a high nutrient profile. Now it’s not that those two are mutually exclusive, but often foods that are highly energy dense, may not necessarily be nutrient dense.  

[00:14:39] So, as a wise colleague of mine put it, he says, you know, people can be eating enough and still starving. In other words, they’re not getting the nutrients they need. And we talk about that there’s another term that you may or may not have heard called food swamp. And the idea there with the food swamp is that there’s lots of calories in a community, but in fact they may not be nutrient dense calories. And so, to really pay attention to not only caloric intake, but nutrient intake, because both are important to have healthy functioning human beings. 

[00:15:17] Tinu: That makes a whole lot of sense. We focus so much on people having more food because of course they’re hungry, but if they’re not getting the right foods, then that’s going to complicate the health problems that they might have. 

[00:15:32] Ben: Just to give you an example, Dr. Dariush Mozaffarian, who’s over at Tufts, I was watching a YouTube interview with him and he cited a statistic that blew me away around SNAP, the Supplemental Nutrition Assistance Program, formally known as food stamps. And one of the things that the statistic he cited was that SNAP beneficiaries are two times more likely to die of heart disease and three times more likely to die of diabetes. And the question is, why is that the case? And so, again, it sort of gets at this idea that it’s not simply about food, in terms of caloric intake. It’s also about ensuring that folks have access to healthy food and in our case with Wholesome Wave, we really focus on healthy fruits and vegetables.  

[00:16:22] Tinu: And Philip was saying about how involved with the groceries in the community and how that further facilitates wellness. So how do institutions, especially grassroots organizations, in the area help to facilitate better solutions to nutrition insecurity that may not be happening in lower income communities before they come along? 

[00:16:47] Ben: So, in thinking about that question and thinking about Phil’s response, which, you know, I was really excited in hearing that because I think in essence, what it speaks to is something that at Wholesome Wave I was able to coin this acronym called the “FED principle”. And the “FED principle” very much comes out of my work being in the public health field for over two decades around what I’ve seen as a public health practitioner really work.  

[00:17:18] And so, the “FED principle”, the F in “FED” stands for fidelity. And the idea that you first and foremost, when engaging in communities, have to have fidelity to those communities. What does fidelity mean? It means being in authentic relationship with the community so that whatever solution is created is a, is a, co-creation, not the old model of experts coming in, swooping in, and telling communities what they need, that ultimately the community has to be part of the solution. And that is foundational. Equity is the idea of identifying barriers to access and doing everything we can to remove those barriers to access. And dignity is respecting the basic foundation that every human being has the right to healthy food. So those things together spell our “FED principle”. 

[00:17:45] And I think the other thing that it gets at, which Phil was alluding to, was the idea that the Good Food Markets are really an example, first of all, of the “FED principle” in action, but the shift from seeing food and grocery markets as simple places of transactions, that it’s simply transactional. What I’m hearing with Good Food Markets, and certainly what we hope to do in our work at Wholesome Wave, is to move from simply that transactional model to a transformational one, which means that from community to community, what their solution looks like may vary.  

[00:18:27] But the fact of the matter is if the community owns, has ownership, in whatever’s created the chances for success increase exponentially because there’s ownership as opposed to having some party come in, swoop in, and again, tell the community what it needs, think it knows what it needs, and then wonder why it’s a failure or it doesn’t take off. So, those are the kinds of things I think a lot about in terms of our work and examples of best practices that I see out in the world. 

[00:19:02] Tinu: I love the idea of transformation versus transactional, because that really clears up what the central issue is, and it also expresses what needs to happen in a very concise way. That makes you still think of the actual, what is happening on the ground in the community. 

[00:19:25] I wanna address this to Philip first: from the perspective of business, how can the smaller grocery stores, that are in the community, operate in ways that are beneficial to both the business and the consumer? And would you say that when it is more lopsided, as it tends to be, that it is more transactional and that having smaller community-based groceries are more transformational or does it kind of depend on how you construct the model?  

[00:19:56] Philip: I think it really does depend on how you construct the model and to Ben’s point of kinda outside groups coming in, thinking they know the answer. You know, you can build the model up, from the foundation, with input and try to actualize what is in demand in the community, whether that be food, products, services, events, what have you. At the end of the day, from the business standpoint, it comes down to – can you sell enough food in the space that you have to cover all of your expenses?  

[00:20:29] And what is really challenging for any small grocery operator, regardless of where they are, or their mission orientation, is that the supermarkets have such huge economies of scale that as a small store you literally can’t buy the product for less than the supermarkets are selling it to the general public for. And that gap in competitiveness is what makes it really challenging, even for those small stores who are willing to take the risk and go into communities that the supermarkets will not, they’re now fighting against all of these market forces that are very difficult to overcome, if at all. And so, I think unlocking that is, is a real key to making community-serving retail work. There’s been a lot of work done in that regard by food banks and municipalities. It is the fundamental challenge of running such a complex low margin business. 

[00:21:27] One other thing I would add, which is: one of the major barriers to community led solutions is that investment. No matter what the project is, it needs financial and other resources to be invested in it in order to have any chance of success, let alone get off the ground. And that is a very difficult case to make, period, for any grocery store. It’s a very risky business. And it’s even harder for an unproven entrepreneur who may not have a model that’s fully baked, or a personal balance sheet to get a small business loan, and all of these structural things that I think follow very directly from what Ben was talking about earlier related to redlining. It’s not only home ownership, but it’s business ownership, and investment in those business communities. And that is, on the front end, like a very tall and very thick wall that keeps a lot of ventures from getting off the ground. 

[00:22:23] Tinu: I was listening to an episode of NPR’s Code Switch and Gene Demby was talking about how, yes, there’s still redlining, but it doesn’t just affect housing because housing kind of affects everything. Housing determines where your kids go to school, it determines where you shop for your groceries, what doctors you go to, because they’re near your house or they’re near your work, how much money goes into your neighborhood from your taxes. It determines so many things about your life. So, if you’re in an area that has been redlined, you get a different level, usually a lower level, of resources. And it’s just like the snowball effect that makes everything lower quality than in other neighborhoods. It’s not this minimally harmful thing. It really does affect every aspect of life.  

[00:23:18] Ben, I see you nodding a lot. Where that’s concerned, a similar question from a business perspective, is there a way that you see that grocery stores can operate in low-income communities in ways that benefits both the business and the consumer? And do you also have ideas to interject about redlining and how that affects it? 

[00:23:40] Ben: I think in terms of the conversation about redlining, and the fact that as you astutely identified, it is so connected to everything. I think about it in, in two ways. I think about the role that the private sector can play, or philanthropy can play, which we’ve enlisted public private partnerships to do work around increasing access to healthy fruits and vegetables. But I also think, I believe resolutely that the prime mover of this situation that we have is the United States government and that the United States government has to play a key role.  

[00:24:27] And I’ll give you an example of how I was struck by the scale of the problem. Back in the end of 2020, we, Wholesome Wave, had the opportunity to be part of a cares relief, food, emergency, access program, getting healthy food to vulnerable communities in Los Angeles county. Los Angeles County’s the largest county in the United States having 10 million people. 25 million dollars for this cares act relief program, six weeks. Now 25 million dollars seems like a lot, doesn’t it? 25 million dollars for six weeks of getting food to vulnerable communities fed roughly 29,000 households, or more or less a hundred thousand people. Six weeks, 25 million dollars, a hundred thousand people. That was just for a very short amount of time to do that.  

[00:25:26] And so, the question you immediately think about is – there are a lot more than a hundred thousand hungry people in the United States, and that was just 25 million dollars, which seems like an enormous amount. So, you then begin to see the scale of a problem and realize that while philanthropy can play a role, private industry can play a role, the fact of the matter is the United States government has to be a key driver. Because ultimately, if you think about, redlining started with the homeowner’s loan corporation, the HOLC back in, I believe, the 1930’s. So, who was the prime mover of this? The United States government. So, it’s just important to keep that in mind, because again, I was blown away and thinking, wow, we got 25 million dollars to do this, and yet it was just, it wasn’t even a drop in the bucket. It was like a little mist in the bucket.  

[00:26:24] Tinu: Wow. Yeah, and you think you know what a lot of money is and then you get a budget for something like that, and it’s gone so fast. That is astonishing. That is just absolutely astonishing. So, 25 million dollars could not stretch the whole county. It’s alarming to realize that, but at the same time look at the rising cost of food and lately how much everybody’s food budget has had to change just to be able to get the same amount of things that they were purchasing before, and you kind of start to see the math in your mind. So, what are some of the health and financial impacts of the lack of healthy food options in low-income communities? 

[00:27:10] Ben: Well, it is sobering because they are significant. So, by some estimates, poor nutrition is a leading cause of sickness in the United States. And to give you a sense of the magnitude – we’re talking about upwards of 600,000 deaths a year associated to lack of access to healthy foods, which is roughly 50,000 people a month in the U.S. 40% of folks in the United States have obesity. One in two have diabetes or prediabetes. In terms of cancer, a full third of all cancers could be prevented with proper nutrition. And then in terms of just the overall costs that cascade and the things like academic achievement because lack of access to healthy food influences things like financial stress, productivity, healthcare costs. The estimates are roughly 1.4 trillion dollars a year to the U.S. economy related to lack of access to healthy foods. So again, sobering and significant.  

[00:28:19] Philip: Yeah, I think that, you know, the impacts, from the health perspective are predominantly obesity, diabetes, heart disease. Ben brought up cancer as well, which he says are a third of which are preventable, in part through healthy diet, and I would add an environmental justice aspect to that as well because where Good Food Markets pilot location started in ward five in DC, has the highest rates of cancer in the district. And also, the highest density of commercial uses, including trash stations and other things that create or handle toxic materials.  

[00:28:54] And this is a real impact outside of direct grocery space, but that is also depressing the earning power of households in the community. If someone is ill, it often means someone else in the family has to stay home and care for that person. So, that’s two people who are sort of out of the workforce, so to speak. And then, shorter life expectancy also means less work, less savings, passing on those savings to the next generation. It has a serious impact, I think, especially over the long term, it gets worse over the long term, on wealth inequality.  

[00:29:24] Tinu: What are some of the solutions that are out there currently that could alleviate the food access issue? And do you see future solutions that you’d like to have implemented?  

[00:29:36] Philip: Yeah, there, there are definitely some new, innovative models out there. Some that I’ve seen that I think are notable are one: is working with nonprofit housing providers to create food access in those spaces. They have bigger budgets, they have existing real estate, they have a built-in demand, in tenants. And I’ve seen that in a few different places where housing providers are essentially underwriting the grocery space in their buildings.  

[00:30:02] In the healthcare side, there’s a store in Akron, Ohio, I believe it is, that is run by a healthcare organization. So again, it’s sort of like a budget line item for them. They see the benefit. I think those kind of investments from organizations, including the public sector, that have a vested financial interest in reducing the downstream costs of health issues by investing in upstream solutions is a really powerful model. I think for the future, what I’d like to see is more examples of creating equity ownership, either in individual entrepreneurs, community groups, so that there’s accountability and wealth building that’s taking place from these efforts. 

[00:30:45] Tinu: Ben? 

[00:30:46] Ben: Wholesome Wave – the vision is, really the, the long game is around the ideas that produce prescriptions. So, a physician or a clinician writing a prescription for access to healthy fruits and vegetables. That’s our vision in terms of a solution, specifically as it relates to having it embedded in government sponsored healthcare programs. Private healthcare as well, but largely thinking about the scale, the magnitude of a Medicaid, which is serving vulnerable populations anyway, to have produce prescriptions embedded in that, to us is a long game to have it be a permanent feature in government sponsored programs. 

[00:31:30] With that said, on the micro or meso level, doing the kind of work in community, using the “FED model”, so that the kinds of produce prescription programs that are developed are community owned and operated. And we can take that data to make the case at the government level for why these programs are so important and why they need to be part of government sponsored healthcare programs. So, that’s kind of the, the big vision, if you will.  

[00:31:58] Tinu: What is a hope that you have for the future of healthcare in general, to become more equitable for everyone? 

[00:32:07] Ben: The vision in terms of healthcare, is that it is equitable. The very definition of equity or justice is that we have a system that is designed so that those at the margins have the same health comes as those at the center. And so that means a lot has to happen in order for that to be realized. But I love what Phil said about the focus on upstream solutions. That a key part of that journey has to be paying attention to the upstream.  

[00:32:45] We’ve spent a lot of time and a lot of resources downstream and some of that has been necessary. But as Dan Heath says in his book called “Upstream”, it’s been wildly asymmetrical. And so, to really start to think about where we can leverage and funnel resources to more upstream solutions so that it cascades down into things like healthy access to fruits and vegetables, healthy foods, healthy education, healthy, you know, healthy, everything. 

[00:33:14] Philip: My hope for the future of healthcare, through my lens of food access, is valuing the work that it takes to actually get to a solution, and the time that requires, and being patient, and being willing to invest to see those long-term population level health outcomes.  

[00:33:33] Tinu: That is really important that it’s seen as a priority. And if it’s seen as a priority, then you’re right, the money should match that intent. Thank you so much for being with us. 

[00:33:44] Philip: Thank you, Tinu. It’s been nice talking with you. 

[00:33:46] Ben: Thanks everyone, be well! 

[00:33:48] [Music] 

[00:33:51] Tinu: Thank you for joining my conversation with Ben Perkins and Philip Sambol. Healthy food access is both a health and social justice issue. As Ben mentioned, the currently used term food apartheid states that “it is no accident where there is a lack of access to healthy food”. Organizations like Wholesome Wave and Oasis Community Partners, where Ben and Philip work, are committed to working on the local consumer level, as well as on the government level, to tackle nutrition insecurity head on.  

[00:34:25] The takeaway learnings from this episode are: 

[00:34:28] 1) Large grocery store chains are not profitable in certain areas, which can create a lack of access to healthy foods in these neighborhoods. To combat this, smaller grocery stores can function in these regions by being large enough to support full, fresh food access, while being small enough to be run by a local team. Grocery stores like these, including Good Food Markets, thrive by being mission driven. 

[00:34:57] 2) Poor nutrition is one of the leading causes of sickness in the United States. On top of it creating preventable health issues, it also depresses the earning power of these communities and reduces opportunities for success in educational settings. 

[00:35:15] 3) The most effective way to ensure communities embrace nutritious food, and a healthy lifestyle, is by democratizing wellness, which allows people to reclaim their autonomy and sovereignty over their own communities, bodies, and health choices through creating community ownership.  

[00:35:35] 4) Finding a solution for food access takes time and flexibility. It requires patience and a willingness to invest in a long-term model. The goal is to reduce downstream cost of health issues by investing in upstream solutions. 

[00:35:54] The actionable tips from this episode are: 

[00:35:58] 1) If you are interested in introducing health education and nutritional access to a community through a grocery store, or otherwise, consider partnering with community groups to bring events and programs to meet people where they are. Social impact and financial sustainability are equally as important for nutrition access ventures. 

[00:36:21] 2) If you are a local leader, or government official, examine neighborhoods where fresh food access may be minimal. Call in community members, local businesses, and philanthropies to support nutrition access and education. 

[00:36:38] For more information on Wholesome Wave and Good Food Markets, have a look at our show notes. 

[00:36:44] Every episode of Health in the Margins has a page on empoweredus.org, where you can find the extended show notes, including tips and takeaways, transcripts, and relevant resource links.   

[00:36:58] If you would like to share your own tips related to this topic or connect with us, please visit the Empowered Us contact page or reach out to us on our social channels.  

[00:37:09] Health in the Margins is an Empowered Us original, presented by Good Days, hosted by me, Tinu Abayomi-Paul. Be sure to rate and subscribe to this show wherever you get your podcasts.   

[00:37:22] As we move from the margins to the center, I wish you the best possible health for your mind, body and soul. You are worthy of the best. And please remember you do not need to earn sleep or rest.  

[00:37:44] [Music Ends]  

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Access to Healthy Food and Mission-Driven Markets

 

In this episode, Tinu speaks with Ben Perkins, the Director of the Board for Wholesome Wave and Philip Sambol, Executive Director of Oasis Community Partners. Together, they discuss the impact of healthy food access, how to create mission-driven markets in low-income communities, and the importance of democratizing wellness.  

“When engaging in communities, we have to have fidelity to those communities. What does fidelity mean? It means being in an authentic relationship with the community so that whatever solution is created is a co-creation, not the old model of experts coming in, swooping in, and telling communities what they need, that ultimately the community has to be part of the solution. And that is foundational.” – Ben Perkins 

 

Timestamps

  • 02:16 Ben and Philip’s 3 aspects that make up their identities 
  • 05:07 What is a food desert 
  • 09:59 The impact of community grocery stores 
  • 12:47 What is food insecurity and how does it happen in low-income communities 
  • 16:22 How do institutions facilitate better solutions to nutrition insecurity in lower income communities 
  • 19:25 How can small grocery stores operate in a way that is beneficial to consumers and the business 
  • 27:00 Impacts of a lack of healthy food options in low-income communities 
  • 29:24 Solutions that are available, and need in the future, to alleviate food access issues

Takeaway Learnings

  1. Large grocery store chains are not profitable in certain areas, which can create a lack of access to healthy foods in these neighborhoods. To combat this, smaller grocery stores can function in these regions by being large enough to support full, fresh food access, while being small enough to be run by a local team. Grocery stores like these, including Good Food Markets, thrive by being mission driven.
  2. Poor nutrition is one of the leading causes of sickness in the United States. On top of it creating preventable health issues, it also depresses the earning power of these communities and reduces opportunities for success in educational settings.
  3. The most effective way to ensure communities embrace nutritious food, and a healthy lifestyle, is by democratizing wellness, which allows people to reclaim their autonomy and sovereignty over their own communities, bodies, and health choices through creating community ownership.
  4. Finding a solution for food access takes time and flexibility. It requires patience and a willingness to invest in a long-term model. The goal is to reduce downstream cost of health issues by investing in upstream solutions.

Actionable Tips

  1. If you are interested in introducing health education and nutritional access to a community through a grocery store, or otherwise, consider partnering with community groups to bring events and programs to meet people where they are. Social impact and financial sustainability are equally as important for nutrition access ventures. 
  2. If you are a local leader, or government official, examine neighborhoods where fresh food access may be minimal. Call in community members, local businesses, and philanthropies to support nutrition access and education. 

Resources Mentioned in the Episode

Additional Resources

About Ben Perkins and Philip Sambol

Ben Perkins is the Director of the Board for Wholesome Wave. Wholesome Wave is a nonprofit organization that combats food and nutrition insecurity across the country by partnering with local organizations to co-design culturally competent programs. 

Philip Sambol is Executive Director of Oasis Community Partners, a DC-based nonprofit dedicated to improving food access and community health. Oasis operates the Good Food Markets social enterprise grocery store chain in the DC area. Good Food Market is a mission-driven business committed to developing retail solutions that work for food desert communities, while addressing food access, economic, and health disparities. Good Food Markets is one of the organizations that Wholesome Wave has partnered with in the DC area. 

Transcript

[00:00:00] [Music] 

[00:00:06] Ben: When engaging in communities, have to have fidelity to those communities. What does fidelity mean? It means being in authentic relationship with the community so that whatever solution is created is a co-creation, not the old model of experts coming in, swooping in, and telling communities what they need, that ultimately the community has to be part of the solution. And that is foundational. 

Read More

[00:00:34] Tinu (Recorded): Hello, and welcome to Health in the Margins. Health in the Margins is a podcast that hosts conversations between experts and community members to investigate disparities and uncover solutions related to diversity and disability in healthcare.  I’m your host Tinu Abayomi-Paul. 

[00:00:56] [Music Ends] 

[00:00:56] Today we’ll be speaking with Ben Perkins and Philip Sambol. Ben is the director of the board for Wholesome Wave. Wholesome Wave combats food and nutrition insecurity across the country by partnering with local organizations to co-design culturally competent programs. Philip is the executive director of Oasis Community Partners, a Washington DC based nonprofit dedicated to improving food access and community health. Oasis operates the Good Food Markets social enterprise grocery store chain in the DC area. Good Food Markets are retail solutions for food desert communities that address food access, economic and health disparities. 

[00:01:40] Philip and Ben work and live in DC and Boston, respectively. Both these cities are taking a supply and demand approach to addressing food access and analyzing how to create sustainable solutions for future generations. Through organizational support and engaging with their communities at large, their organizations are analyzing and working together to improve the government driven and economic factors that marginalize against nutrition access in certain communities. 

[00:02:08] [Music] 

[00:02:10] Welcome to Ben Perkins and Philip Sambol! 

[00:02:16] [Music Ends] 

[00:02:16] Tinu: Thank you both for being here. Thank you so much, Ben. Thank you, Philip. Great to have you. To start out with, we all have a variety of aspects that make up who we are as a person. If you, Ben, had to distill this down into three identities, what would those identities be? And how do they relate to your work in food access? 

[00:02:39] Ben: That is a great question. I think the three identities that for me, uh, really have been instrumental in my public health career, and informing my public health career, has been being African American, descended from enslaved folks. The other one is being queer, uh, a gay man. And, the other one I think is just being curious, being a human being that always has asked uncomfortable questions about why things are the way they are. And those three things, certainly the last one, was there from the beginning. And the other two I’ve come to understand how they play out in the world. But I think they all are connected to the issue of justice at the end of the day. And why do some have, and why do some not have? So, I would think those sort of three things come to mind, in terms of that question. 

[00:03:44] Tinu: That is really great. I’m particularly interested in that last part. I think that’s a really great one because not everybody is curious. A lot of people just kind of accept the world the way it is and don’t think about, “Hey, why is that like that? How can we change that? Is there anything that we can do?” But there’s so much that we can all do as individuals, once we decide to empower ourselves. Phillip? 

[00:04:09] Philip: Thanks Tinu. It’s great to be here. I think the identities came to mind for me: one is a contrarian, like just sort of looking at the other side, even if it ends up being a dead end, but, taking that other view. Um, as a creator, someone who always tries to build something new to see what that next stage of evolution is, and try to push things there. And then as a connector of ideas and people and being connected by people and ideas. And I think those three identities, aspects of my own personality really relate to the food access work because the prevailing wisdom here is that grocery stores won’t work in food deserts. So, you have to be somewhat of a contrarian to even consider that idea, building something new and pulling all of those connections together. 

[00:05:00] Tinu: There’s the three C’s in there to make it really easy to remember. I love it. You mentioned food deserts, which is a topic that I am wild about and that I like to talk a lot about. And the concept of a food desert is a really difficult thing to explain to people who haven’t experienced that. You know, people will say, “oh, why don’t you just buy some fresh fruit?” “Okay, from where?” So, both of you, but Philip first, would you expand on the concept of a food desert and how that plays into wellness, especially in lower income neighborhoods? 

[00:05:40] Philip: Certainly. So, I think just to start the, you know, USDA definition of food deserts, uh, in the urban context is no fresh food access, full-service grocery store, within either half a mile or one mile. Um, there are other factors, transportation, household vehicle access, income, that are relevant, but essentially places in our biggest cities, all across the country, where you can’t buy fruits and vegetables, or healthy food.  

[00:06:08] And you know, the prevailing wisdom here, as I mentioned is that, grocery store won’t work in communities that don’t have one because of the economics, because of the residential density. And I think from our perspective, at Good Food Markets, we don’t necessarily disagree with that, but the average supermarket in the U.S. is 45,000 square feet. And there is a universe of store sizes below that that could work.  

[00:06:33] And so, our model has been smaller stores that are less expensive to build, more efficient to operate, that are sized to meet the demand. Being big enough to support full, fresh food access, like a traditional grocery store, but small enough to run on a local team. And, and all of that being driven by mission driven or mission-oriented partners who want to see the health outcomes. And so, I think that’s the, the core economic problem and kind of how solutions are viewed.  

[00:07:07] Ben: So first off, the thing that I often like to raise when the term food desert comes up is: food desert is a verb, not a noun. And what I’m getting at is another term that folks particularly more socially justice minded use, which is food apartheid. And the idea that it’s no accident, largely, that we see the neighborhoods that we see, uh, with a lack of access to healthy foods. And particularly I think about the phenomena of redlining, and the history of redlining, and communities, primarily BIPOC communities, that were essentially sort of identified, marked as being undesirable.  

[00:07:52] And therefore, there’s a whole cascade of things that happened as a result of being labeled undesirable that echo, reverberate, even to today. And one of those is a lack of access to things like healthy foods, because there haven’t been investments, and some argue that there have been significant disinvestment and disincentives in those neighborhoods. And so, you see what you see and it’s no accident. And that’s why you see higher rates of cardiovascular disease, all the other things that go along with the term food desert. 

[00:08:28] Tinu: Food apartheid – that is a new term for me. Philip, on your website it talks about how wellness is democratized, “democratizing wellness” was the phrase. Would you tell us more about that in terms of the role of community grocery stores and facilitating that concept?  

[00:08:44] Philip: Absolutely. So that turn of phrase was actually written by our community health manager, who worked with us for several years, started as an intern, and, worked her way up to a, a full-time position with us, and the thinking behind using that phrase of democratizing wellness really gets to what Ben was just saying, that this is about people reclaiming their autonomy, and their sovereignty over their own communities, bodies, health, choices. And that’s what Good Food Markets is striving to do.  

[00:09:19] So, I think that, you know, we’re not successful in all things and we’re not successful all the time, but putting the fresh food in the community, at an affordable price, partnering with community groups, bringing events and programs to the space, going out into the neighborhood, meeting people where they are, and talking about their food choices, and how they view food as a part of their health, and what health means to them. And then trying to build the store around those concepts while always providing healthy, fresh alternatives to what’s there, which is predominantly carry out, fast food, corner store. 

[00:09:59] Tinu: What is the impact of the community grocery store? I just noticed that, especially when I was looking at your social media, I saw a lot of community posts that weren’t directly related to the grocery store. And I wouldn’t see that from say a big grocery chain. How are you involved in the community and is that part of the whole plan with a community grocery store or did that just organically come out of the intent of the store? 

[00:10:29] Philip: I would say both. It was absolutely an intentional part of the strategy from the beginning, community engagement, at a basic level, just to let people know what Good Food Markets is, where we are, and that we exist, to solicit that feedback and have that conversation that I was just describing. And then, as things progressed, and we opened the store, and we were operating, we started to meet groups that were mission aligned, but that they’d be at urban agriculture schools, YMCA, senior centers, who were looking for opportunities to provide health education, that the grocery store was a great platform to do. And so, over time we’ve worked with over 50 organizations to present everything from like basic cooking classes, all the way up to programs that are evaluated by academic institutions. 

[00:11:21] Good Food Markets is part of a case study that’s coming up from Robert Wood Johnson Foundation later this year that looked at 10 different community-oriented grocery stores across the country, and how they were similar, how they were different, how they were doing performance-wise, in social impacts and in financial sustainability.  

[00:11:39] And the big takeaways there for me were that one: there’s no real national replicable model here. The things that are working at a local level all require some type of ongoing operating support, but that choosing the right location, engaging with the community in a real and meaningful way from the beginning, and continuing that through to action stage, providing the products that people want at a price they can afford, and having this champion. And they’re different in each place, but there was one person who was either the fundraiser, or the operator, or just a great community leader who wanted to see this happen and sustain. Those are the things that have survived.  

[00:12:20] So, I think that that really speaks to the community being the engine for success here, regardless of the structure built around it. Like we’re a nonprofit owned store, there are nonprofit stores, there are food banks that have added annex. There’s all sorts of ways to go about this, but that it’s community informed, community driven, and what we hope to get to is community owned. 

[00:12:43] Tinu: I would love to have a community owned store in my area. So, Ben, what is nutrition insecurity? First of all, how’s it come to be? Why does it need to be addressed in low-income communities? Why is it most prevalent there? 

[00:12:59] Ben: So, what I’m gonna do is tell you a little bit about how the USDA talks about it, because it’s a fairly recent term, in terms of its’ usage. And interestingly enough, the USDA recently came out with a whole statement about nutrition insecurity. And there’s sort of – think about the old school sort of Venn diagram. This concept, which I think a lot of people are familiar with, which is food security or insecurity.  

[00:13:26] And so, nutrition insecurity is kind of, if you wanna think about a subset, or within the realm of food insecurity, but the USDA says it means “consistent access, availability, and affordability, of foods and beverages that promote wellbeing, prevent disease, and if needed treat disease, particularly among racial and ethnic minority populations, lower income populations, and rural and remote populations, including tribal communities in insular areas.”  

[00:13:59] So, one of the ways I like to talk about it is: if you think about food insecurity you think about the idea of people getting enough to eat. Which is important, you know, you get enough calories to keep your engine running, but the reality is not all foods are the same. And, some have talked about foods, sort of the differentiation between foods that are energy dense, have a lot of calories, versus foods that are nutrient dense, which have a high nutrient profile. Now it’s not that those two are mutually exclusive, but often foods that are highly energy dense, may not necessarily be nutrient dense.  

[00:14:39] So, as a wise colleague of mine put it, he says, you know, people can be eating enough and still starving. In other words, they’re not getting the nutrients they need. And we talk about that there’s another term that you may or may not have heard called food swamp. And the idea there with the food swamp is that there’s lots of calories in a community, but in fact they may not be nutrient dense calories. And so, to really pay attention to not only caloric intake, but nutrient intake, because both are important to have healthy functioning human beings. 

[00:15:17] Tinu: That makes a whole lot of sense. We focus so much on people having more food because of course they’re hungry, but if they’re not getting the right foods, then that’s going to complicate the health problems that they might have. 

[00:15:32] Ben: Just to give you an example, Dr. Dariush Mozaffarian, who’s over at Tufts, I was watching a YouTube interview with him and he cited a statistic that blew me away around SNAP, the Supplemental Nutrition Assistance Program, formally known as food stamps. And one of the things that the statistic he cited was that SNAP beneficiaries are two times more likely to die of heart disease and three times more likely to die of diabetes. And the question is, why is that the case? And so, again, it sort of gets at this idea that it’s not simply about food, in terms of caloric intake. It’s also about ensuring that folks have access to healthy food and in our case with Wholesome Wave, we really focus on healthy fruits and vegetables.  

[00:16:22] Tinu: And Philip was saying about how involved with the groceries in the community and how that further facilitates wellness. So how do institutions, especially grassroots organizations, in the area help to facilitate better solutions to nutrition insecurity that may not be happening in lower income communities before they come along? 

[00:16:47] Ben: So, in thinking about that question and thinking about Phil’s response, which, you know, I was really excited in hearing that because I think in essence, what it speaks to is something that at Wholesome Wave I was able to coin this acronym called the “FED principle”. And the “FED principle” very much comes out of my work being in the public health field for over two decades around what I’ve seen as a public health practitioner really work.  

[00:17:18] And so, the “FED principle”, the F in “FED” stands for fidelity. And the idea that you first and foremost, when engaging in communities, have to have fidelity to those communities. What does fidelity mean? It means being in authentic relationship with the community so that whatever solution is created is a, is a, co-creation, not the old model of experts coming in, swooping in, and telling communities what they need, that ultimately the community has to be part of the solution. And that is foundational. Equity is the idea of identifying barriers to access and doing everything we can to remove those barriers to access. And dignity is respecting the basic foundation that every human being has the right to healthy food. So those things together spell our “FED principle”. 

[00:17:45] And I think the other thing that it gets at, which Phil was alluding to, was the idea that the Good Food Markets are really an example, first of all, of the “FED principle” in action, but the shift from seeing food and grocery markets as simple places of transactions, that it’s simply transactional. What I’m hearing with Good Food Markets, and certainly what we hope to do in our work at Wholesome Wave, is to move from simply that transactional model to a transformational one, which means that from community to community, what their solution looks like may vary.  

[00:18:27] But the fact of the matter is if the community owns, has ownership, in whatever’s created the chances for success increase exponentially because there’s ownership as opposed to having some party come in, swoop in, and again, tell the community what it needs, think it knows what it needs, and then wonder why it’s a failure or it doesn’t take off. So, those are the kinds of things I think a lot about in terms of our work and examples of best practices that I see out in the world. 

[00:19:02] Tinu: I love the idea of transformation versus transactional, because that really clears up what the central issue is, and it also expresses what needs to happen in a very concise way. That makes you still think of the actual, what is happening on the ground in the community. 

[00:19:25] I wanna address this to Philip first: from the perspective of business, how can the smaller grocery stores, that are in the community, operate in ways that are beneficial to both the business and the consumer? And would you say that when it is more lopsided, as it tends to be, that it is more transactional and that having smaller community-based groceries are more transformational or does it kind of depend on how you construct the model?  

[00:19:56] Philip: I think it really does depend on how you construct the model and to Ben’s point of kinda outside groups coming in, thinking they know the answer. You know, you can build the model up, from the foundation, with input and try to actualize what is in demand in the community, whether that be food, products, services, events, what have you. At the end of the day, from the business standpoint, it comes down to – can you sell enough food in the space that you have to cover all of your expenses?  

[00:20:29] And what is really challenging for any small grocery operator, regardless of where they are, or their mission orientation, is that the supermarkets have such huge economies of scale that as a small store you literally can’t buy the product for less than the supermarkets are selling it to the general public for. And that gap in competitiveness is what makes it really challenging, even for those small stores who are willing to take the risk and go into communities that the supermarkets will not, they’re now fighting against all of these market forces that are very difficult to overcome, if at all. And so, I think unlocking that is, is a real key to making community-serving retail work. There’s been a lot of work done in that regard by food banks and municipalities. It is the fundamental challenge of running such a complex low margin business. 

[00:21:27] One other thing I would add, which is: one of the major barriers to community led solutions is that investment. No matter what the project is, it needs financial and other resources to be invested in it in order to have any chance of success, let alone get off the ground. And that is a very difficult case to make, period, for any grocery store. It’s a very risky business. And it’s even harder for an unproven entrepreneur who may not have a model that’s fully baked, or a personal balance sheet to get a small business loan, and all of these structural things that I think follow very directly from what Ben was talking about earlier related to redlining. It’s not only home ownership, but it’s business ownership, and investment in those business communities. And that is, on the front end, like a very tall and very thick wall that keeps a lot of ventures from getting off the ground. 

[00:22:23] Tinu: I was listening to an episode of NPR’s Code Switch and Gene Demby was talking about how, yes, there’s still redlining, but it doesn’t just affect housing because housing kind of affects everything. Housing determines where your kids go to school, it determines where you shop for your groceries, what doctors you go to, because they’re near your house or they’re near your work, how much money goes into your neighborhood from your taxes. It determines so many things about your life. So, if you’re in an area that has been redlined, you get a different level, usually a lower level, of resources. And it’s just like the snowball effect that makes everything lower quality than in other neighborhoods. It’s not this minimally harmful thing. It really does affect every aspect of life.  

[00:23:18] Ben, I see you nodding a lot. Where that’s concerned, a similar question from a business perspective, is there a way that you see that grocery stores can operate in low-income communities in ways that benefits both the business and the consumer? And do you also have ideas to interject about redlining and how that affects it? 

[00:23:40] Ben: I think in terms of the conversation about redlining, and the fact that as you astutely identified, it is so connected to everything. I think about it in, in two ways. I think about the role that the private sector can play, or philanthropy can play, which we’ve enlisted public private partnerships to do work around increasing access to healthy fruits and vegetables. But I also think, I believe resolutely that the prime mover of this situation that we have is the United States government and that the United States government has to play a key role.  

[00:24:27] And I’ll give you an example of how I was struck by the scale of the problem. Back in the end of 2020, we, Wholesome Wave, had the opportunity to be part of a cares relief, food, emergency, access program, getting healthy food to vulnerable communities in Los Angeles county. Los Angeles County’s the largest county in the United States having 10 million people. 25 million dollars for this cares act relief program, six weeks. Now 25 million dollars seems like a lot, doesn’t it? 25 million dollars for six weeks of getting food to vulnerable communities fed roughly 29,000 households, or more or less a hundred thousand people. Six weeks, 25 million dollars, a hundred thousand people. That was just for a very short amount of time to do that.  

[00:25:26] And so, the question you immediately think about is – there are a lot more than a hundred thousand hungry people in the United States, and that was just 25 million dollars, which seems like an enormous amount. So, you then begin to see the scale of a problem and realize that while philanthropy can play a role, private industry can play a role, the fact of the matter is the United States government has to be a key driver. Because ultimately, if you think about, redlining started with the homeowner’s loan corporation, the HOLC back in, I believe, the 1930’s. So, who was the prime mover of this? The United States government. So, it’s just important to keep that in mind, because again, I was blown away and thinking, wow, we got 25 million dollars to do this, and yet it was just, it wasn’t even a drop in the bucket. It was like a little mist in the bucket.  

[00:26:24] Tinu: Wow. Yeah, and you think you know what a lot of money is and then you get a budget for something like that, and it’s gone so fast. That is astonishing. That is just absolutely astonishing. So, 25 million dollars could not stretch the whole county. It’s alarming to realize that, but at the same time look at the rising cost of food and lately how much everybody’s food budget has had to change just to be able to get the same amount of things that they were purchasing before, and you kind of start to see the math in your mind. So, what are some of the health and financial impacts of the lack of healthy food options in low-income communities? 

[00:27:10] Ben: Well, it is sobering because they are significant. So, by some estimates, poor nutrition is a leading cause of sickness in the United States. And to give you a sense of the magnitude – we’re talking about upwards of 600,000 deaths a year associated to lack of access to healthy foods, which is roughly 50,000 people a month in the U.S. 40% of folks in the United States have obesity. One in two have diabetes or prediabetes. In terms of cancer, a full third of all cancers could be prevented with proper nutrition. And then in terms of just the overall costs that cascade and the things like academic achievement because lack of access to healthy food influences things like financial stress, productivity, healthcare costs. The estimates are roughly 1.4 trillion dollars a year to the U.S. economy related to lack of access to healthy foods. So again, sobering and significant.  

[00:28:19] Philip: Yeah, I think that, you know, the impacts, from the health perspective are predominantly obesity, diabetes, heart disease. Ben brought up cancer as well, which he says are a third of which are preventable, in part through healthy diet, and I would add an environmental justice aspect to that as well because where Good Food Markets pilot location started in ward five in DC, has the highest rates of cancer in the district. And also, the highest density of commercial uses, including trash stations and other things that create or handle toxic materials.  

[00:28:54] And this is a real impact outside of direct grocery space, but that is also depressing the earning power of households in the community. If someone is ill, it often means someone else in the family has to stay home and care for that person. So, that’s two people who are sort of out of the workforce, so to speak. And then, shorter life expectancy also means less work, less savings, passing on those savings to the next generation. It has a serious impact, I think, especially over the long term, it gets worse over the long term, on wealth inequality.  

[00:29:24] Tinu: What are some of the solutions that are out there currently that could alleviate the food access issue? And do you see future solutions that you’d like to have implemented?  

[00:29:36] Philip: Yeah, there, there are definitely some new, innovative models out there. Some that I’ve seen that I think are notable are one: is working with nonprofit housing providers to create food access in those spaces. They have bigger budgets, they have existing real estate, they have a built-in demand, in tenants. And I’ve seen that in a few different places where housing providers are essentially underwriting the grocery space in their buildings.  

[00:30:02] In the healthcare side, there’s a store in Akron, Ohio, I believe it is, that is run by a healthcare organization. So again, it’s sort of like a budget line item for them. They see the benefit. I think those kind of investments from organizations, including the public sector, that have a vested financial interest in reducing the downstream costs of health issues by investing in upstream solutions is a really powerful model. I think for the future, what I’d like to see is more examples of creating equity ownership, either in individual entrepreneurs, community groups, so that there’s accountability and wealth building that’s taking place from these efforts. 

[00:30:45] Tinu: Ben? 

[00:30:46] Ben: Wholesome Wave – the vision is, really the, the long game is around the ideas that produce prescriptions. So, a physician or a clinician writing a prescription for access to healthy fruits and vegetables. That’s our vision in terms of a solution, specifically as it relates to having it embedded in government sponsored healthcare programs. Private healthcare as well, but largely thinking about the scale, the magnitude of a Medicaid, which is serving vulnerable populations anyway, to have produce prescriptions embedded in that, to us is a long game to have it be a permanent feature in government sponsored programs. 

[00:31:30] With that said, on the micro or meso level, doing the kind of work in community, using the “FED model”, so that the kinds of produce prescription programs that are developed are community owned and operated. And we can take that data to make the case at the government level for why these programs are so important and why they need to be part of government sponsored healthcare programs. So, that’s kind of the, the big vision, if you will.  

[00:31:58] Tinu: What is a hope that you have for the future of healthcare in general, to become more equitable for everyone? 

[00:32:07] Ben: The vision in terms of healthcare, is that it is equitable. The very definition of equity or justice is that we have a system that is designed so that those at the margins have the same health comes as those at the center. And so that means a lot has to happen in order for that to be realized. But I love what Phil said about the focus on upstream solutions. That a key part of that journey has to be paying attention to the upstream.  

[00:32:45] We’ve spent a lot of time and a lot of resources downstream and some of that has been necessary. But as Dan Heath says in his book called “Upstream”, it’s been wildly asymmetrical. And so, to really start to think about where we can leverage and funnel resources to more upstream solutions so that it cascades down into things like healthy access to fruits and vegetables, healthy foods, healthy education, healthy, you know, healthy, everything. 

[00:33:14] Philip: My hope for the future of healthcare, through my lens of food access, is valuing the work that it takes to actually get to a solution, and the time that requires, and being patient, and being willing to invest to see those long-term population level health outcomes.  

[00:33:33] Tinu: That is really important that it’s seen as a priority. And if it’s seen as a priority, then you’re right, the money should match that intent. Thank you so much for being with us. 

[00:33:44] Philip: Thank you, Tinu. It’s been nice talking with you. 

[00:33:46] Ben: Thanks everyone, be well! 

[00:33:48] [Music] 

[00:33:51] Tinu: Thank you for joining my conversation with Ben Perkins and Philip Sambol. Healthy food access is both a health and social justice issue. As Ben mentioned, the currently used term food apartheid states that “it is no accident where there is a lack of access to healthy food”. Organizations like Wholesome Wave and Oasis Community Partners, where Ben and Philip work, are committed to working on the local consumer level, as well as on the government level, to tackle nutrition insecurity head on.  

[00:34:25] The takeaway learnings from this episode are: 

[00:34:28] 1) Large grocery store chains are not profitable in certain areas, which can create a lack of access to healthy foods in these neighborhoods. To combat this, smaller grocery stores can function in these regions by being large enough to support full, fresh food access, while being small enough to be run by a local team. Grocery stores like these, including Good Food Markets, thrive by being mission driven. 

[00:34:57] 2) Poor nutrition is one of the leading causes of sickness in the United States. On top of it creating preventable health issues, it also depresses the earning power of these communities and reduces opportunities for success in educational settings. 

[00:35:15] 3) The most effective way to ensure communities embrace nutritious food, and a healthy lifestyle, is by democratizing wellness, which allows people to reclaim their autonomy and sovereignty over their own communities, bodies, and health choices through creating community ownership.  

[00:35:35] 4) Finding a solution for food access takes time and flexibility. It requires patience and a willingness to invest in a long-term model. The goal is to reduce downstream cost of health issues by investing in upstream solutions. 

[00:35:54] The actionable tips from this episode are: 

[00:35:58] 1) If you are interested in introducing health education and nutritional access to a community through a grocery store, or otherwise, consider partnering with community groups to bring events and programs to meet people where they are. Social impact and financial sustainability are equally as important for nutrition access ventures. 

[00:36:21] 2) If you are a local leader, or government official, examine neighborhoods where fresh food access may be minimal. Call in community members, local businesses, and philanthropies to support nutrition access and education. 

[00:36:38] For more information on Wholesome Wave and Good Food Markets, have a look at our show notes. 

[00:36:44] Every episode of Health in the Margins has a page on empoweredus.org, where you can find the extended show notes, including tips and takeaways, transcripts, and relevant resource links.   

[00:36:58] If you would like to share your own tips related to this topic or connect with us, please visit the Empowered Us contact page or reach out to us on our social channels.  

[00:37:09] Health in the Margins is an Empowered Us original, presented by Good Days, hosted by me, Tinu Abayomi-Paul. Be sure to rate and subscribe to this show wherever you get your podcasts.   

[00:37:22] As we move from the margins to the center, I wish you the best possible health for your mind, body and soul. You are worthy of the best. And please remember you do not need to earn sleep or rest.  

[00:37:44] [Music Ends]  

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