One Food Desert at a Time

Improving Community Health: One Food Desert at a Time

MD4Assgn2 Reynolds K.

Improving Community Health: One Food Desert at a Time

K. Reynolds (student name)

Example of Health Promotion Proposal

*This proposal is being used as an example by Dr. Allison Litton with permission from the student.

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Improving Community Health: One Food Desert at a Time

Introduction

Food Insecurity and Food Deserts

According to the United States Department of Agriculture (USDA) food insecurity is the

inability to access to adequate food for an active and healthy life (Camp, 2015). Camp (2015)

goes on to suggest that food insecurity has been increasing since 1995 and that in 2011

approximately 15% of all households in America experience food insecurity. The USDA also

proposes that food deserts are areas, often located in low income communities, that do not have

access to healthy food options due to a lack of full service supermarkets (American Nutrition

Association, 2015). Food insecurity and food deserts are increasingly problematic for children

and minorities. A research study conducted in 2012 found that between 12% to 15% of Black

and Hispanic children elementary aged children experienced food insecurity (Xu, Zhu, &

Bresnahan, 2016). Camp (2015) cites that 25.1 % of Black households and 26.2% of Hispanic

households’ experience food insecurity. The US Department of Health and Human Services

(2014) states that approximately 30 million Americans live food deserts with a large percentage

being people of color.

Alabamians also face the complications of food insecurity and food deserts. The

Alabama Food Bank Association (2016) reports that 19.2% of Alabama’s population or almost 1

million people live with food insecurity. Furthermore, 1.8 million Alabamians live in areas

without full service supermarkets (Lang, Koprak, & Treering, 2015). In fact, almost every

county in Alabama has difficulty providing access to healthy food options (Lang, Koprak, &

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Improving Community Health: One Food Desert at a Time

Treering, 2015). In Birmingham 40% of the population lives in a food desert and currently there

are only 24 full service supermarkets for a population of 212,000 (Change Lab Solutions, 2012).

Health Problems Related to Food Insecurity and Food Deserts

The impact that food insecurity and food deserts have on public health is unequivocal.

Several studies have noted a possible relationship between obesity and food insecurity (Camp,

2015) Camp (2015) also noted that poorly controlled diabetes, hypertension, and heart disease

are were significantly higher among individuals living with food insecurity. Brown & Brewster

(2015) support this idea by hypothesizing that there is a link between food insecurity and

sedentary lifestyles, cancer, arthritis, and metabolic syndrome. Ortega et al (2014) posits that the

exponential growth of obesity and chronic illnesses can be traced to the insufficient intake of

healthy foods that occurs within food deserts.

Alabamians face even higher rates of obesity and chronic disease. Nationwide the rate

for obesity is 68% and the rate for diabetes is 6% however, 75% of the residents in Birmingham

have been diagnosed as overweight or obese and approximately 11% have been diagnosed with

diabetes (Lang, Koprak, & Treering, 2015). The Alabama Department of Health (2015) states

the following statistics:

 In 2012 Alabama ranked fifth among the nation’s top eight obese states

 From 2010-2012 more than 35,919 Alabamians died from heart disease

 Preventable strokes caused approximately 7,759 Alabama deaths in 2010-2012

 In 2008-2010 Alabama had the highest rate of stroke incidents in the nation

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Improving Community Health: One Food Desert at a Time

Much current research supports the idea that making healthy food available in food deserts is a

strategy that will help citizens to make better food choices thus improving health outcomes

(Centers for Disease Control and Prevention, 2014). They go on to state that having access to

full service supermarkets increases fruit and vegetable consumption and can possibly lower the

prevalence of obesity for adults. The Alabama Department of Public Health (ADPH) (2015)

cites that 24.3% of adults in Alabama eat vegetables less than once daily and 43.8 % eat fruit less

than once daily. Increasing access to healthy food options within food deserts will improve the

health outcomes of Alabamians and help to alleviate obesity and chronic diseases (The Food

Trust, 2015).

The Program Initiative

The South Park Invests in Fresh Foods (SPIFF) intervention will work collaboratively

with the Urban Food Project to provide access to healthy food choices to the residents in the

West End Area of Birmingham, Alabama. The Urban Food Project, an economic development

organization located in Birmingham, Alabama, believes in developing creative ways to make

fresh fruits and vegetables available to residents of food deserts. Their research has shown that

residents shop in stores that are most convenient to them and providing food in easily accessible

and unconventional venues gives citizens access to healthier foods (Change Lab Solutions,

2012). SPIFF will utilize the South Park Health Food Store as a venue to provide fresh fruits and

vegetables for residents in West End.

Target Audience and Location

Birmingham covers 43 square miles has 23 communities and 99 neighborhoods (Marie

Gallagher Research & Consulting Group, 2010). Per Marie Gallagher Research & Consulting

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Improving Community Health: One Food Desert at a Time

Group (2010) 88,409 Birmingham residents live in areas that experience food insecurity or are

food deserts. The West End Community has been identified as a food desert with the closest

healthy food store being twice the distance of the nearest unhealthy food store (Marie Gallagher

Research & Consulting Group, 2010). The West End area is covers 4.7 miles and has a

population of 15, 588 (Urban Mapping, 2016). The target audience for this intervention will be

the residents of West End neighborhood. The South Park Seventh Day Adventist Church located

at 414 South Park Road Birmingham, Alabama will be the selected venue for SPIFF

intervention. Locating SPIFF in the church’s health food store will allow physical space for the

fresh fruit and vegetables as well as affording the opportunity to promote food literacy to

customers.

Needs Assessment

The purpose of the needs assessment was to examine the number of people that

experience food insecurity on a monthly basis and the various ways in which people are food

insecure. The needs assessment identified the target audience by conducting a review of the

available literature on food insecurity and food deserts nationwide and in Alabama, by

examining statistics from the US Department of Agriculture’s Food Environment Atlas (2016),

and by conducting a community assessment. The community assessment consisted of face to

face surveys in the West End area. The surveys sought to understand how the following factors

influenced food insecurity:

 Proximity to a nearest grocery store

 Transportation to and from store

 Type of store available near residents

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Improving Community Health: One Food Desert at a Time

 Number of residents receiving food assistance

 Number of days during the month food insecurity is experienced

 Chronic health issues

 Socio-economic factors (race, income, education)

The needs assessment also examined urban maps for the West End Community and noted that

the community had been identified as a food desert. Since the entire community was located

within a food desert all residents of the West End Community would be eligible for participation

in the SPIFF intervention. Surveys were returned and results tabulated and it was discovered that

40% of those surveyed were experiencing food insecurity at some point during the month.

Surveys also showed that residents were interested in having access to healthy foods and

understanding how to properly use healthy foods. Residents were invited to four planning

meetings to discuss health needs related to living in a food desert, healthy food preparation, and

additional community needs that could be addressed by the SPIFF program.

Socio-ecological Factors

The following socio-ecological factors are related to food insecurity and food deserts:

 Median household income

 Availability of food stores

 Neighborhood

 Quality of food accessible

 Dependence on food assistance programs

 Knowledge about managing healthy foods

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Improving Community Health: One Food Desert at a Time

 Employment Level

Stakeholders

Stakeholder #1 South Park Health Ministries Committee- The South Park Church Health

Ministries Committee is committed to reducing food insecurity and food deserts in the West End

community by providing financial assistance for the purchase of fresh produce weekly, offering

fresh produce at a reasonable price, providing food bank services, and providing food literacy to

community members

Stakeholder#2 Residents of the West End Community- West End residents have expressed

concern about how residing in food deserts has a direct relationship to years of life (Marie

Gallagher Research & Consulting Group, 2010). They believe that having access to healthy

food options and having food literacy on how to manage healthy foods will improve community

health and add quality years to life. As stakeholders, they will work toward community buy in

by all residents in West End.

Stakeholder#3 Urban Food Project- The Urban Food Project works to create innovative

solutions to food insecurity and food deserts (Change Lab Solutions, 2012). They will provide

training to the SPIFF program on proper food handling techniques, assistance on ordering the

proper amount of produce, as well as provide logistic support such as delivering produce weekly.

Stakeholder # 4 The Alabama Food Bank- The Alabama Food Bank will continue to provide

support to the SPIFF program. The SPIFF program will purchase additional food from the Food

Bank for distribution at no cost to West End residents

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Improving Community Health: One Food Desert at a Time

Stakeholder # 5 Jefferson County Department of Health- The Jefferson County Department

of health is committed to developing partnerships with the local community that will build a

healthy community through circulating health data, holding community members accountable for

their health decisions and celebrating each other’s success They will provide nutritional

educational information to support the food literacy component of the SPIFF program.

Stakeholder Collaboration Strategy

Stakeholder engagement will be crucial to the success of the SPIFF intervention.

Insufficient stakeholder involvement can lead to overlooking components that are essential to the

success of the program thus resulting in an initiative that does not function as intended.

Priorities will be developed by the group and based on what the group wants to accomplish

through the SPIFF intervention. Once priorities have been established the group will list the

anticipated goals of the intervention. In the event, there is a conflict the leader of the South Park

Health Ministries committee will act as a facilitator to ensure that a group consensus has been

reached (McKenzie, Neiger, & Thackeray, 2009). The Health Ministries leader will establish

subcommittees that will address ideals that are not listed as primary goals. These special interest

subcommittees will address these sub-goals. The chart below demonstrates the stakeholder

collaboration strategy.

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Improving Community Health: One Food Desert at a Time

Collaboration Strategy

Allowing all stakeholders to have a say in the development of priorities and goals will

create buy in from all parties (McKenzie, Neiger, & Thackeray, 2009).

Mission, Goals, and Objectives

Mission Statement

The mission of the South Park Invests in Fresh Food (SPIFF) health initiative is to eliminate food

insecurity and food deserts in the West End neighborhood by providing regular access to fresh

produce at affordable prices.

Goal

 To reduce and ultimately eliminate food insecurity and food deserts in the West End area

of Birmingham, Alabama

Priorities/Goals •Establisehd by stakeholders

Conflicts

•Addressed by Health Ministreis Leader

Subgoals

•Addressed by subcommittees established by Health Ministries Leader

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Improving Community Health: One Food Desert at a Time

Objectives

 By December 31, 2018 the majority of West End residents will increase fruit and

vegetable consumption from < than one time daily to intake ranges recommended by

Healthy People 2020 (U.S. Department of Health and Human Services and U.S.

Department of Agriculture, 2016)

 By August 31, 2017 food insecurity will be reduced by 50% for the residents of West

End

 By December 31, 2018 one hundred percent of the residents of West End will have

regular access to fresh fruit and vegetables

 By December 31, 2018 the majority of West End Residents will receive food literacy

training in healthy food preparation

Theoretical framework

The theoretical framework that was used in the development of the SPIFF

intervention was the Health Belief Model (HBM). The HBM was selected because it

focused on the concerns the residents of West End have about the relationship between

years of life, diet quality, food deserts and food insecurity (Marie Gallagher Research &

Consulting Group, 2010). This concern led residents to believe that their health was

being impacted by living in a food desert with limited access to fresh healthy food

options. Residents saw the lack of healthy food options within their community as a

barrier to good health and desired to bring healthier food choices into their community.

West End citizens believe that if they have regular access to healthy foods community

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Improving Community Health: One Food Desert at a Time

health will be drastically improved. The chart below demonstrates how the Health

Belief Model was utilized in the SPIFF intervention.

Health Belief Model

Intervention strategy

The intervention strategy that will be utilized by the SPIFF intervention is environmental

change. This strategy will target the lack of accessibility to fresh produce and other health food

options within the West End community. This community level intervention will focus on

providing affordable and open access to healthy food options regularly to program participants.

Activities

The two main activities that the SPIFF intervention program will be involved in are:

 Providing weekly access to healthy food options at an affordable prices

Health Belief Perceptions Eliminating Food Deserts

Perceived susceptibility Not eating enough healthy foods can be bad

for health

Perceived seriousness Too many high fat, calorie foods can cause

chronic health problems (diabetes, high blood

pressure, heart disease)

Perceived benefit Having access to health foods can eliminate

risk for chronic disease and improve health

Perceived barriers No access for healthy foods, cost, knowledge

on preparing healthy foods

Likelihood of taking actions If healthy foods are readily available at a

reasonable cost action can be taken

Self-efficacy Residents will feel empowered to make

healthier food choices

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Improving Community Health: One Food Desert at a Time

 Providing food literacy to program participants

Each of these activities will be critical to eliminating food insecurity and food deserts in the West

End neighborhood. The HBM suggests that individual health actions depend on the belief that a

one is vulnerable to a particular health threat, that taking a certain course of action might avert

the threat, that there are possible barriers to reducing that threat, and that once barriers have been

removed it is possible to achieve the desired result (McKenzie, Neiger, & Thackeray, 2009).

Many individuals who live in food deserts believe that regular access to healthy food is not

possible because of lack of access to full service food markets, lack of reliable transportation,

and lack of money. According to Change Lab Solutions (2015) many Birmingham residents live

on food budgets of less than $600 monthly making healthy eating difficult. Making healthy

eating more challenging for those living in food deserts is that fact that as much as 15 % of

Birmingham’s population lack reliable transportation (Change Lab Solutions, 2015). Current

research shows that removing the barriers of access improves community health (Lang, Koprak,

& Treering, 2015). Providing weekly access to healthy food options will remove the barrier of

not having regular access to healthy food options at an affordable price.

Having regular access to healthy food options will not be effective without also providing

food literacy. According to Vidgen & Gallegos (2014) Food literacy is composed of being able

to properly manage foods with confidence. Program participants must have a clear

understanding of how to manage healthy food choices. Training classes that focus on the eleven

components of food literacy will target the barrier of not understanding how to utilize healthy

food options. The eleven components of food literacy are:

 Prioritize money and time

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Improving Community Health: One Food Desert at a Time

 Plan for regular access to food

 Make good food choices based on food needs and resources

 Access food through a variety of sources

 Demonstrate knowledge about food products

 Demonstrate knowledge about food quality

 Demonstrate ability to prepare palatable food from available resources

 Understand the principles of food handling

 Understand the relationship between food and health

 Understand the need to eat balanced meals

 Enjoying the social aspects of sharing meals (Vidgen, 2015)

Both activities will support the HBM by reducing barriers to healthy food access and helping

program participants to achieve self-efficacy.

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Improving Community Health: One Food Desert at a Time

Logic Model

Program: South Park Invests in Fresh Food (SPIFF) Logic Model Situation: Food Deserts/Food Insecurity

Funding from South Park Health Ministries Department Produce at reduced price from Urban Food Project Food Literacy Training

Fresh Food Market

Residents of West End Community

Food Literacy Training

Increase fruit and vegetable consumption to recommended daily allowances

Inputs Outputs Activities Participation

Outcomes Short Medium Long

Program participants will receive Food Literacy training

100% of residents will participate in food program

Assumptions: Health Ministries Department will continue funding as needed Urban Food Project will continue to deliver produce at reduced prices Food Literacy Training will increase number of residents utilizing the program

External Factors Health Ministries may lose funding from church Program costs may increase Urban Food Project may not be able to continue food delivery at reduced prices

Reduce food insecurity by 50%

Eliminate food desert in West End community

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Improving Community Health: One Food Desert at a Time

References

Alabama Department of Public Health. (2015). 2015 state of Alabama community health

improvement plan. Retrieved from

adph.org/accreditation/assets/CHIP_2015_RevAugust.pdf

Alabama Food Bank Association. (2016). Hunger in Alabama. Retrieved from

www.alfoodbanks.org/?page_id=11

American Nutrition Association. (2015). USDA defines food deserts | American Nutrition

Association. Retrieved from http://americannutritionassociation.org/newsletter/usda-

defines-food-deserts

Brown, D. R., & Brewster, L. G. (2015). The food environment is a complex social network.

Social Science & Medicine, 133, 202-204. doi:10.1016/j.socscimed.2015.03.058

Camp, N. L. (2015). Food insecurity and food deserts. The Nurse Practitioner, 40(8), 32-36.

doi:10.1097/01.npr.0000453644.36533.3a

Change Lab Solutions. (2015). Food as a catalyst for change | ChangeLab Solutions. Retrieved

from http://www.changelabsolutions.org/publications/food-catalyst-change

Lang, B., Koprak, J., & Treering, D. (2015). The need for healthy food access in Alabama.

Retrieved from The Food Trust website: http://thefoodtrust.org/uploads/media_items/al-

reportfinalweb.original.pdf

Ortega, A. N., Albert, S. L., Sharif, M. Z., Langellier, B. A., Garcia, R. E., Glik, D. C., …

Prelip, M. L. (2014). Proyecto Mercado FRESCO: A multi-level, community-engaged

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corner store intervention in East Los Angeles and Boyle Heights. Journal of Community

Health, 40(2), 347-356. doi:10.1007/s10900-014-9941-8

The Food Trust. (2015). Food for every child: The need for healthy food financing in

Alabama. Retrieved from http://thefoodtrust.org/uploads/media_items/al-

reportfinalweb.original.pdf

U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2016,

February 4). 2015–2020 dietary guidelines for Americans – health.gov. Retrieved from

http://health.gov/dietaryguidelines/2015/

United States Department of Agriculture. (2016). Food Environment Atlas. Retrieved from

https://www.ers.usda.gov/data-products/food-environment-atlas/go-to-the-atlas/

US Department of Health and Human Services. (2015). Healthy food financing initiative |

Office of community services | administration for children and families. Retrieved from

https://www.acf.hhs.gov/ocs/programs/community-economic-development/healthy-

food-financing

Vidgen, H. A. (2015). Food Literacy. Nutridate, 26(3), 5-6. doi:10.4324/9781315708492

Vidgen, H. A., & Gallegos, D. (2014). Defining food literacy and its components. Appetite, 76,

50-59. doi:10.1016/j.appet.2014.01.010

Xu, X., Zhu, X., & Bresnahan, M. (2016). Fighting Back: Inner-city community responses to

food insecurity. American Behavioral Scientist, 60(11), 1306-1321.

doi:10.1177/0002764216657380