food access projects across the country through the foods, a nutritious diet and good health are out of cafreshworks/pdfs/CFWF_FactSHT_9.pdf. 4.

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Find this report online at ©2013 by PolicyLinkAll rights reserved. Design by: Leslie Yang Cover photo courtesy of: Photos courtesy of: PolicyLink is a national research and action institute advancing economic and social equity by Lifting Up What Works ®.The Food Trust, founded in 1992, is a nonpro˜ t organization working to ensure that everyone has access to affordable, nutritious food.

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4The nation is abuzz with talk about good, healthy food, but for far too many people, and especially for those living in low-income communities and communities of color, healthy food is simply out of reach. Finding quality fresh food means either traveling signi˜cant distances or paying exorbitant prices for wilting vegetables and overripe fruit. With these burdens, it is no surprise that these same communities face the highest risks of obesity, diabetes, and other preventable food-related health challenges. Yet, these are the very communities that are driving the nation™s population growth and upon whom the country™s future will depend. What will America™s future be like if we do not ˜x this problem and end these disparities? In recognition of this, PolicyLink and The Food Trust a have been working together over the past ˜ve years to advance policies to help entre- preneurs and food retailers build or expand stores in underserved communities. Bringing grocery stores to low-income underserved areas creates a healthier food environment that supports making healthier choices: having easy, regular access to grocery stores or other food markets that sell fruits, vegetables, produce, and other staples at affordable prices is necessary to eat the well- a In most of this work, we have partnered with The Reinvestment Fund. rounded, nutritious diet essential for good health. Supermarkets and other retail outlets that sell hea- lthy foods are also major contributors to strong, local economies. Supermarkets, for example, are often fieconomic anchorsfl that draw in the foot traf˜c to support additional stores. They not only create many local jobs, but also foster other commercial development and breathe new life into neighborhoods that have been disinvested for decades. Successful advocacy by hundreds of organi- zations working to promote equity, health, entre- preneurship, and community development has helped bring over $1 billion in resources to healthy food access projects across the country through the federal Healthy Food Financing Initiative and similar efforts in more than 10 states and localities. We have proudly helped to spark and support a virtual explosion of innovative healthy food retail projects in a vast number of urban, suburban, and rural low-income communities. Research, of course, has been essential to both understanding the problem and developing effective solutions. And the research community has been thoroughly engaged with this issue. Over the past three years, at least 170 studiesŠmore than in the previous two decadesŠhave been published. These studies have examined what Preface

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6Healthy food retailersŠgrocery stores; farmers™ markets; cooperatives; mobile markets; and other vendors of fresh, affordable, nutritious foodŠare critical components of healthy, thriving communities. As the country inches its way out of the Great Rec- ession and seeks to grow a more sustainable and equitable economy, ensuring that healthy food is accessible to all is crucial. Without access to healthy foods, a nutritious diet and good health are out of reach. And without grocery stores and other fresh food retailers, communities are also missing the commercial vitality that makes neighborhoods livable and helps local economies thrive. Moreover, the challenge of access to healthy food has been a persistent one for communities of color. Beginning in the 1960s and 1970s, white, middle-class and working-class families left urban centers for homes in the suburbs, and supermarket chains went with them, leaving many inner- city neighborhoods with few or no full-service marketsŠoften for decades. Limited access to healthy food also plagues many rural communities and small towns, where population losses and economic changes have diminished food retail options. Even in agricultural centers where fruits and vegetables are being grown, residents may not have a retail outlet nearby. Many of the communities that lack healthy food retailers are also oversaturated with fast-food restaurants, liquor stores, and other sources of inexpensive, processed food with little to no nutritional value. For decades, community activists have organized around the lack of access to healthy foods as an economic, health, and social justice issue. Healthy food retailers can generate signi˜cant economic stimulus by serving as anchors for further commercial revitalization, creating local jobs, gen- erating tax revenues, and capturing local dollars within the community, among other economic and community development outcomes. 1, 2 For example, it is estimated that 24 new jobs are created for every 10,000 square feet of retail grocery space, 3 so a very large market can generate between 150 and 200 full- and part-time jobs. 1 Attracting and incentivizing new or improved healthy food retail in communities of color and low-income, urban, and rural communities is an important component of a comprehensive strategy to revitalize disinvested areas by improving health and economic outcomes in the places that need it most. As concerns have grown over the worsening obesity epidemic, access to healthy and affordable food has moved to the forefront of community, civic, and policymakers™ agendas. A shared recognition of the role that healthy food access plays in promoting stronger local economies, vibrant neighborhoods, and healthy people has sparked support for diff- erent projects and initiatives, bringing an array of approaches from grocery stores to farmers™ markets, mobile markets, food hubs, and community gardens. Even as recognition of the problem is growing and progress is being made, between 6 and 9 percent of all U.S. households are still without access to healthy food. Nearly 30 million people live in low- income areas with limited access to supermarkets (de˜ned as the closest store being more than a mile away). 4 The problem is particularly acute in low- income communities of color. People living in these neighborhoods must either make do with the foods available in smaller local stores, which are very often less healthy and more expensive, or spend nearly 20 minutes traveling to the nearest large retailer or even more time in rural communities where a full-service grocery store may be more than 20 miles away. 5 There has been a proliferation of innovative approaches to bringing healthy food retail into underserved communities in recent years. The best- known large-scale innovation is the highly successful Pennsylvania Fresh Food Financing InitiativeŠa statewide public-private effort that helped develop Introduction

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7or improve 88 supermarkets, smaller independently owned grocery stores, farmers™ markets, and other fresh food outlets in underserved urban communities, small towns, and rural areas throughout Pennsylvania. Launched in 2004, the initiative leveraged more than $190 million in healthy food retail projects over six years and is responsible for creating or retaining more than 5,000 jobs in Pennsylvania communities. 6, b This program has so far been adapted and funded in six other states and cities, bringing much-needed ˜nancial resources and development know-how to communities seeking to improve healthy food access. Several more jurisdictions are in the process of starting funding for similar initiatives. The federal Healthy Food Financing Initiative (HFFI), established in 2011, has, in three years, distributed more than $500 million in grants and tax credits to improve access to healthy food in communities across the country. The President has proposed to expand the program further in 2014. In total, more than $1 billion in private capital has already been lev- eraged to support an array of different projects and approachesŠnot only full-scale grocery stores but also consumer co-operatives, farmers™ markets, mobile markets, and food hubs. Thousands of jobs have been created, and hundreds of thousands of people have new access to healthy food. The local and state-level efforts con˜rm that sup- port for healthy food retail can come in many forms and that new models are emerging at a fast pace. Improving offerings at corner stores and bodegas, starting or expanding farmers™ markets and mobile markets, enhancing community gardens and other forms of urban agriculture, and initiating new forms of wholesale distribution through food hubs are among the promising strategies that bring economic and health bene˜ts to neighborhoods. The local economy, development resources, community leadership and support, political will, and other factors determine what is possible and viable. In 2010, PolicyLink and The Food Trust published The Grocery Gap: Who Has Access to Healthy Food and Why It Matters, a comprehensive review of the previous two decades™ worth of food access research. The review found overwhelming evidence that access to healthy food was particularly limited for low- income communities, communities of color, and rural b In addition to state legislative leadership, the initiative arose from the work of Pennsylvania-based nonpro˜t organizations including The Food Trust and The Reinvestment Fund, with strong support from the food retailing industry. communities. The research also suggested that access to healthy food corresponds with a good diet and lower risk for obesity and other diet-related chronic diseases. A third, more emergent, theme in the literature was that new and improved healthy food retail in underserved communities creates jobs and helps to revitalize low-income neighborhoods. Given the proliferation of research since the 2010 Grocery Gap publication, it was determined important to systematically review the new studies and reevaluate the evidence base. This new report does that, pro- viding an up-to-date summary of what is known about access to healthy food and why it matters. The majority of the evidence continues to supportŠor strengthenŠthree primary ˜ndings: Accessing healthy food is still a challenge for many families, particularly those living in low- income neighborhoods, communities of color, and rural areas. Living closer to healthy food retail is among the factors associated with better eating habits and decreased risk for obesity and diet-related diseases. Healthy food retail stimulates economic activity. While most of the newer research continues to point to positive health and economic impacts, some contradicting results have also surfaced. As this report documents, however, the majority of research still indicates that in order for people to improve their diets they need to have convenient access to good quality, healthy food. The proliferation of local efforts to provide access to healthy food has drawn attention to the factors that can determine the impact of these innovations, including transportation access and the quality, price, and cultural appropriateness of the offerings. As more studies of local circumstances are published, a more complete picture is emerging of the realities for people living in low-income urban neighborhoods, communities of color, and rural areas with limited access. There is also more clarity about what happens to purchasing, consumption, health outcomes, and the local economy when access changes. The following summary of the state of the research can inform policymakers , advocates, researchers, philanthropic organizations, and others in identifying, designing, and implementing strategies to ensure all people have access to healthy food.

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9The ˜eld of healthy food access research has bene˜ted from rapid growth and wider attention in the last three years. The result of this increased scrutiny and documentation is a more well-rounded understanding of the problems and the emergence of a literature that describes impacts at both the individual and community levels. The results from the review of the literature are organized by the three main ˜ndings described in the introduction and elaborated upon in this section. 1. Accessing healthy food is a challenge for many families, particularly those living in low- income neighborhoods, commu- nities of color, and rural areas. An overwhelming body of evidence over 20 years indicates that accessing affordable, high-quality, and healthy food is a challenge for many families; this challenge is most pronounced in low-income neighborhoods of color. 4, 7-170 Recent national-scale studies conducted by the United States Department of Agriculture™s Economic Research Service (USDA ERS) and The Reinvestment Fund have found that 25 to 30 million AmericansŠabout 9 percent of the total populationŠare living in communities that do not provide adequate access to healthy food retailers, such as supermarkets or grocery stores, within a reasonable distance c from their home. 4, 142 Both c The Reinvestment Fund (TRF) considers a fireasonable distancefl to be one that is ficomparatively acceptablefl to the distance traveled by residents in well-served areas. TRF de˜nes ficomparatively acceptablefl as the distance that residents of well- served areas (block groups with incomes greater than 120 percent of the area™s median income) travel to the nearest supermarket. The USDA de˜nes fireasonable distancefl as the presence of a supermarket within one mile of a person™s residence. studies found that the populations living in these communities are more likely to be low-income and to be people of color. Where Are Food Deserts Located? In an effort to help identify the communities that can most bene˜t from targeted resources and strategies to improve healthy food access, the United States Department of Agriculture (USDA) and The Reinvestment Fund have developed and launched free data sources that assist in the identi˜cation of areas lacking healthy food access, or food deserts. 171 The Food Access Research Atlas (USDA) and PolicyMap (The Reinvestment Fund) both, with varying levels of complexity, visually depict gaps in healthy food access across the country. From 1990 through February 2013, many studies have documented how low-income communities and communities of color have less access to healthy food than higher-income and less diverse communities. A national cross-sectional study found that low-income, urban neighborhoods of color have the least availability of grocery stores and supermarkets compared with both low- and high-income white communities.172 A 2012 comprehensive review of published literature about the role of the retail food environment in shaping racial, ethnic, and socioeconomic disparities in obesity risk con- cluded that the retail environments of comm- unities of color lack accessibility to healthy food, while the opportunities to purchase processed, convenience foods and alcohol are great. 100 In an assessment of nearly 1,200 residents in Baltimore, Maryland, white, college-educated, and higher-income households have signi˜cantly higher availability of healthy food options Findings

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