Unfortunately, access can differ drastically depending on where someone lives. Because of this, the health behaviors that reduce cancer risk are much harder to implement for some than others. In many cases, rural communities and neighborhoods with low-income individuals or racial and ethnic minorities face added barriers to health. For example, rural residents often live miles from the nearest source of fresh, healthy food. This lack of access is one of several reasons why rural households face food insecurity at a higher rate than urban households. According to Feeding America, 9 out of 10 high food insecure counties are rural, and 8 out of 10 counties are located in the South. In comparison to neighborhoods with higher household income residents, neighborhoods with lower income residents feature fewer sports areas, parks, greenways, well-maintained sidewalks or bike paths. Rural communities lack the availability of public transit or close proximity of residential areas to everyday destinations, such as retail stores and schools, that help promote more daily physical activity in urban areas. The places people live can also impact their tobacco and alcohol use. Research shows that neighborhoods featuring an overabundance of convenience or liquor stores, and thus more advertising for alcohol and tobacco products, contribute to disparities in use rates. These retailers tend to cluster in neighborhoods with a high percentage of low-income residents or residents of color.  

While there is no one-size-fits all solution, there are a number of ways state and local governments, along with community partners, can work to reduce these disparities so everyone has the opportunity to be healthy, regardless of where they live. A few examples include: 

1. Providing support and resources for existing food retailers by assisting with food distribution challenges and establishing healthy retail programs 
2. Developing affordable and efficient transportation services for neighborhoods without convenient access to healthy food retail venues and adopting Complete Street policies to ensure streets are designed to be safely used by all
3. Supporting shared use agreements so that existing facilities, such as schools, can be used for physical activity by the broader community 
4. Decreasing the density of alcohol and tobacco outlets through licensing or zoning restrictions

By building healthier communities for all, we have the potential to make a profound impact on the health behaviors that are proven to reduce cancer risks.

Healthy Active Communities sets out to explore and expand conversations around the impacts of policy and systems change to reduce chronic conditions in communities through health equity, nutrition security with weight-inclusive approaches.

The 2022 conference will be a great place for students and professionals in national, tribal, state and local public health; community organizations and nonprofits; and, health care and nutrition professionals to contribute and learn. We hope insight from across the United States will foster innovation, enthusiasm, and progress in communities around Oregon and beyond.

Counter Tools staff member Mollie Mayfield will be presenting on healthy retail and the retail environment as a social determinant of health. Other conference topics include Strategies for De-Emphasizing BMI for More Equitable Health Promotion, Racist Origins of Anti-Fat Bias, Food Justice, Marketing Unhealthy Foods to Children (especially children of color), Building an Equity Foundation for Sugary Drinks Policy, and more.

Learn more about the conference, speakers, and agenda at HealthyActiveCommunities.com.

Register for the virtual conference here.

We often see innovative policy solutions tested first at the local-level. In this webinar, you’ll learn about alcoholic beverage regulations in Montgomery County, the sole “control” jurisdiction in the state of Maryland and one of very few jurisdictions across the country to use this model. You’ll hear about efforts at the county level in Maryland to advance policies that make the food and beverage options on restaurant kids’ meal menus healthier, with a strategy of spreading these policies throughout the state and an eye towards a state-level law.

We also highlight the City of Berkeley, California, the first city in the nation to levy a tax on sugar-sweetened beverages, as well as the first in the country to pass a healthy checkout policy.

In this third webinar of the Local Control webinar series on August 22, CADCA’s Geographic Health Equity Alliance, in collaboration with Counter Tools share details about these local solutions. The three-part webinar series equips attendees with an understanding of why local policy solutions are important, lessons learned from local policy implementation efforts and innovative policy strategies built at the local-level.

View the recording:

Local Control webinar series

CADCA’s Geographic Health Equity Alliance, in collaboration with Counter Tools hosted a three-part webinar series to equip attendees with an understanding of why local policy solutions are important, lessons learned from local policy implementation efforts and innovative policy strategies built at the local-level.

Webinar 1: Building the Rationale for Local Policy Change. Speakers provided a broad rationale for local-level policy efforts and the implications for public health, as well as insight on strategies that have proven successful for local policy implementation.

Webinar 2: Using Local Momentum to Drive State and Federal Policy Change. This webinar featured leaders from the Tobacco 21 and smokefree air movements to discuss how tobacco control policy strategies at the local level helped drive policy change across the country.

Webinar 3:  Innovative Local Solutions in Public Health. The third webinar in the series covered local-level policy solutions in Maryland and California. These efforts advanced policies relating to alcohol and healthy food.

The U.S. Department of Agriculture (USDA) recently released a re-evaluation of the Thrifty Food Plan, used to calculate Supplemental Nutrition Assistance Program (SNAP) benefits. Starting in October, the average SNAP benefit will increase by 25%.

SNAP is the largest U.S. food assistance program that provides monthly benefits to low-income households to support their food budget. Families need to have access to nutritious, affordable foods to maintain good health and reduce risk of disease. There are strong ties between food insecurity and poor health outcomes. Due to health and social inequities, certain racial and ethnic minority groups are disproportionately affected by food insecurity and have higher rates of diet-related conditions such as diabetes and obesity. Predominantly black and Hispanic neighborhoods have fewer full-service supermarkets than predominantly white and non-Hispanic neighborhoods, which can be one of the barriers to accessing healthy foods. The pandemic resulted in elevated levels of food insecurity and exacerbated inequities, with estimates of 1 in 5 Black individuals experiencing food insecurity in 2020.

The Thrifty Food Plan outlines nutrient-dense foods and beverages, their amounts, and associated costs that can be purchased on a limited budget to support a healthy diet through nutritious meals and snacks at home. The report was last updated in 2006, and the Agricultural Improvement Act of 2018 now requires the USDA to reevaluate the Thrifty Food Plan every five years. This plan is used to inform the SNAP benefits provided to low-income families.

A study of barriers for SNAP recipients found price to be the largest barrier to a healthy diet, with 60 percent citing affordability. Using food prices inflated to June 2021, the cost of weekly amounts of foods and beverages that support a healthy diet for a typical family of four is now $835.57 per month, which is a 21 percent increase since the last evaluation. 30 percent of survey participants cited lack of time as another barrier that prevents them from preparing healthy meals. The new Thrifty Food Plan takes into account convenience and ease of preparation, such as precut vegetables or canned beans.

This version of the Thrifty Food Plan is significant as it is the first time in decades that maintaining costs was not a driving factor. The USDA focused on assessing foods and beverages that create a healthy, practical diet, and then determined their cost. One of the goals was ensuring a variety of food choices that are more realistic of a family’s needs and reflect the purchasing and consumption patterns of the diverse U.S. population. The plan allows individuals to follow their own dietary preferences and cultural norms while they select nutrient-dense foods and beverages, such as lower cost chicken breast alongside soy milk. This plan is more representative and realistic than previous editions and may result in more families making healthy food choices, as well as shine a more positive light on the SNAP program.

This reevaluation is an important step towards supporting food security and nutrition security. Studies have shown that SNAP improves food security and the latest increase in benefits should have a positive impact affecting even more families in need.

Download the full Thrifty Food Plan from the USDA here (PDF)

Research has clearly shown that obesity is a risk factor for a wide variety of negative health outcomes, including several types of cancer. It is no coincidence that we see geographic trends in obesity prevalence. This webinar explained the connection between where we live, work and play and the impact it has on obesity, why this matters to cancer control programs and what policy options could help address these issues.

The presenter was Elizabeth Gerndt, Project Director at Counter Tools.

View the recording:

Download the slide deck: Cancer, Obesity, and Place (PDF)

The Geographic Health Equity Alliance (GHEA) is a CADCA initiative. GHEA is a CDC funded National Network dedicated to reducing geographic health disparities related to tobacco and cancer. 

As we reflect on 2020, a year of few non-essential trips outside the home, one of the places we continued to visit was the local grocery or convenience store. Whether we realize it or not, what is available at our local store plays a significant role in the behaviors we choose. Especially in the most disadvantaged communities, access to fresh produce is often limited, while there are plenty of sources for tobacco, alcohol and fast food. In the United States, tobacco use, poor nutrition and excessive alcohol use are among the leading causes of preventable deadly illness, including heart disease, cancer and chronic lower respiratory diseases. The retail environment provides many of the products that result in these health behaviors. Each type of product generally falls under the purview of different public health practitioners (e.g., tobacco control, nutrition, alcohol misuse prevention), but the retail environment is an area these practitioners can, and should, work together to make safer.

The Retail Environment

The retail environment includes both the community environment (e.g., number, type and location of stores) and the consumer environment (e.g., what products are sold, how they are advertised and prices).

What can we do to create a retail environment where the healthy choice is the easy choice? Some important strategies involve addressing the availability, promotion and price of tobacco products, foods and beverages and alcohol in stores. To do this, public health practitioners and policy makers should:

• Limit the availability of tobacco and alcohol products, especially those that target youth.
  Prohibiting the sale of flavored tobacco products, including menthol, is the most comprehensive policy, but other ordinances can be designed to limit the types and proximity of stores selling flavored tobacco. While retailers can also decide to self-regulate, such as the decision by CVS to stop selling tobacco in 2014, local policies are more effective in creating sustainable change.

• Increase promotion of healthy products, while decreasing the advertising and prominence of alcohol and tobacco products.
  This includes placing healthy options in prime locations, like eye-level or at the check-out.

• Support stores in increasing their availability of nutritious food.
  Sometimes this involves providing physical improvements such as display shelving, refrigeration and freezers. If a store owner is not already selling fresh produce or other nutritious items, they may need training and technical assistance around procuring and stocking these products. Ideally, these products should be high quality and available at affordable prices.

• Encourage stores to participate in federal food benefit programs.
  Retailers that accept the Supplemental Nutrition Assistance Program (SNAP) or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits are required to meet certain stocking requirements of nutritious foods identified by the federal government. Along with increasing the availability of nutritious products in stores, participation in federal food benefit programs is important for ensuring healthy food is affordable for low-income shoppers.

• Increase prices on alcohol and tobacco products.
  Research indicates that price plays a major role in purchasing behavior, so increasing prices can be an effective strategy in decreasing smoking and excessive drinking rates. Prices can be increased through imposing higher taxes or using non-tax approaches, such as prohibiting discounts or setting minimum price laws.

At Counter Tools, we believe the retail environment has so much potential to be health assets for our communities, and we’re excited to see new and continued collaborative efforts with partners, like the Geographic Health Equity Alliance, to make healthy retail a reality for everyone.

This post was originally published as a feature article for The Geographic Health Equity Alliance (GHEA), a CADCA initiative. GHEA is a CDC funded National Network dedicated to reducing geographic health disparities related to tobacco and cancer. 

We have a new success story about our partner in Wisconsin that serves as a good example of the importance of collecting data about the retail environment, having cross-sector collaboration in efforts, and increasing access to healthy products for the betterment of population health.

Counter Tools has partnered with the Wisconsin Department of Health Services (WI-DHS) since 2016 to assist with data collection, provide understanding of data/trends, and support change related to tobacco, alcohol and food products in the retail environment.

WI-DHS implemented the Wisconsin Retail Assessment Project (WRAP) annually, from 2016-2019, to document the advertising for and availability of tobacco, alcohol and food products in the state. Some goals of WRAP were to increase knowledge about the retail environment, identify disparities, foster community awareness, and build public support towards interventions.

Coalitions participating in WRAP were tasked with assessing stores/retailers through completing store assessments. Hundreds of licensed stores/retailers were assessed across the state from 2017 – 2019 as part of the data collection process for food and alcohol. Counter Tools worked with Wisconsin to develop a new survey form and program it into an online data collection tool, and helped create a comprehensive and accurate retailer list.

In addition to providing technical assistance throughout the data collection process, Counter Tools analyzed the assessment data at both the county and state-level and created infographics and factsheets for food and alcohol.

A local collaborative worked with each store manager to develop personalized strategies for improvement, such as purchasing fruit baskets and shelf signage, offering training on stocking healthy options, and helping advertise successes with media outreach.

Wisconsin found that better understanding the retail environment, using the assessment data collected to identify specific areas for change, increasing community awareness, and starting conversations with stores were effective strategies in moving things forward.

Read the full success story here.

Our partners have achieved great successes in public health. We recognize their hard work and leadership in creating healthier communities. We hope these stories inspire your work around place-based public health. View more Success Stories on Our Impact page.

Do you have a success story to share? Reach out at hello@countertools.org!

Just how the tobacco retail environment plays a role in smoking behaviors, the food retail environment is an important driver for dietary choices. Unlike the abundance of tobacco retailers available in low-income neighborhoods, many of these same neighborhoods lack access to traditional supermarkets and other sources of fresh, healthy food, especially at an affordable price. Many healthy retail initiatives often focus on encouraging small stores to offer high quality and affordable healthy foods and beverages. Generally, these strategies can be implemented more quickly and at a lower cost than developing new supermarkets in areas with limited healthy food access. Public health practitioners at the local level can play a valuable role in improving access, availability, and affordability of healthier foods and beverages.

Here are a few strategies recommended by the CDC to create healthier small food stores:

Support physical improvements for access to healthier foods

In order to increase the capacity of small stores to sell healthy foods, interior improvements are often necessary. These improvements include items such as display shelving, refrigeration, and freezers. In addition, exterior improvements, such as signage, painting, lighting, and graffiti or litter removal, can also help to improve community perception of a store and raise awareness about interior changes. If retailers are new to stocking fresh foods like produce, they may benefit from training and technical assistance on food safety recommendations.

Assist with promotion and marketing of healthier foods

Every year, food and beverage manufacturers dedicate billions of dollars to in-store marketing efforts, such as prominent placement, discount pricing, and other promotion efforts. In many cases, this in-store marketing is focused on unhealthy products, especially in low-income communities and communities of color. However, these same types of marketing strategies can be used to promote healthier foods. Some of these interventions may include adding shelf labeling or other point-of-purchase prompts to guide customers to healthier choices, advertising healthier foods, having lower price points for healthier items, or placing healthier options at eye level or in check out areas or other prominent places. Cooking demonstrations and taste tests are other examples of in-store marketing opportunities that may be valuable to the community. Additional research is needed to fully understand the most effective marketing strategies for increasing healthy food purchases.

Encourage small stores to accept nutrition assistance program benefits

Ensuring small food stores accept nutrition assistance benefits of programs like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP) is an important part of making sure healthy food is affordable for low-income shoppers. To become an approved vendor for WIC or SNAP, stores are generally required to meet specific stocking requirements of healthy foods which is sometimes challenging for small retailers. Public health practitioners can play an important role in raising community awareness about the retailers that accept federal nutrition assistance programs and the availability of healthy food options.

Offer guidance to improve distribution systems for healthy food

For small store owners, procurement is often a major barrier to stocking healthy foods. In many cases, wholesales only offer produce in quantities that are too large for stores to sell before the product spoils. Delivery fees and minimum purchase requirements can also make this option cost-prohibitive for small food retailers. There are a wide range of innovative strategies public health professionals have used to assist store owners with procurement. Some of these ideas include connecting local food suppliers directly to retailers, creating small store buying groups, and establishing partnerships with larger grocery stores or institutions. Another key part of decreasing financial risk for store owners is ensuring there is community demand for new product offerings, which is why strategies like community outreach, and in-store promotion and marketing are so important.

Making healthy choices easier in the retail environment has the potential to make a significant impact on the health of communities. This impact can even be amplified by taking a comprehensive approach to healthy retail initiatives, including strategies that incorporate tobacco use prevention, nutrition and alcohol prevention partners.

Counter Tools can help support public health practitioners in planning healthy retail initiatives. Send us an email at hello@countertools.org to learn more!

Photo by Mehrad Vosoughi on Unsplash

If you’ve read our blog before, you’ve likely seen us highlight the many ways the retail environment influences tobacco prevalence. Interestingly, many of these same general concepts also apply to the food environment, with research pointing to how the places we live, work, and play contribute to our risk of obesity. The fact that access to healthy food or safe places to be active is inconsistent across communities means that education alone won’t be enough to reduce the burden of obesity in the United States.

This is why we are excited to read about the work of Trust for America’s Health (TFAH) to provide evidence-based policy recommendations for addressing the obesity crisis. Not only do these recommendations focus on the need for a multi-sector, multi-disciplinary approach, but they also focus on those population groups that are disproportionately impacted by the obesity crisis. For example, data from The National Health and Nutrition Examination Survey (NHANES) and The Behavioral Risk Factor Surveillance System (BRFSS) illustrate that socioeconomic factors including poverty and race/ethnicity (see chart below) contribute to an increased rate of obesity. Unfortunately, the COVID-19 pandemic is expected to only exacerbate these existing health disparities.

We’ve listed an overview of TFAH’s recommendations below, but we encourage you to check out the full The State of Obesity 2020 report for the actionable steps for accomplishing these goals at both the federal and state/local level.

1. Increase health equity by strategically dedicating federal resources to efforts that reduce obesity-related disparities.
2. Decrease food insecurity while improving nutritional quality of available foods.
3. Change the marketing and pricing strategies that lead to health disparities.
4. Make physical activity and the built environment safer and more accessible for all.
5. Work with the healthcare system to close disparities and gaps in clinic-to-community settings.

Public health advocates are increasingly focused on interventions that address social drivers of health. With produce prescriptions, healthcare providers address food security in the healthcare setting by connecting their patients with prescriptions for healthy fruits and vegetables. Reinvestment Partners manages several produce prescription programs across North Carolina and partners with Food Lion (a grocery chain) to provide access to fruits and vegetables. These programs are non-medical interventions that improve health, and they hold the potential to effect systems change in healthcare.

The webinar speakers were Neal Curran, Director of Food Programs at Reinvestment Partners and Sam Hoeffler, Food Programs Manager at Reinvestment Partners. Learn more about their work at ReinvestmentPartners.org.

During this webinar, the speakers discussed what produce prescriptions are, how they can improve population health, and the role they can play in altering the way we provide healthcare in the United States.

This webinar is over, but you can view the recording below. You can also download the slides from the webinar along with Massachusetts’ helpful “Food is Medicine” plan that was referenced during the webinar. 

Below is a video by Reinvestment Partners on their produce prescription process for enrollees.

The webinar was Tuesday, September 22nd from 2-3pm EST. Thank you to everyone who joined us!