Bad Meat and Brown Bananas: Building a Legacy of Health by Confronting Health Disparities around Food

By David C. Sloane for the African Americans Building a Legacy of Health Coalition /REACH 2010 Project

What do planners have to do with food? Since 1999, community residents, community organizations and researchers in planning and health have been working to understand food security in the Los Angeles area and to increase options for healthier eating in low-income communities of color. This participatory partnership is using planning and organizing techniques to build capacity among community members to make healthier environments for all.

In 1999, a Los Angeles health advocacy organization, the Community Health Councils, Inc. (CHC), was awarded a grant from the Centers for Disease Control and Prevention (CDC) to develop a plan to address health disparities in cardiovascular disease and diabetes among African Americans in South Los Angeles. The grant was part of a nationwide CDC demonstration program, REACH (Racial and Ethnic Approaches to Community Health), focusing on a single racial or ethnic group and only on issues related to the selected illnesses. The Community Health Councils spent a year in conversations with a broad coalition of African American community and social service organizations as well as community residents. African Americans Building a Legacy of Health (AABLH) ended up with a plan that targeted the communities of North Long Beach, Inglewood and portions of South Los Angeles for three strategic directions: recreating community norms through community education; supporting policy and institutional change through community empowerment; and (the one that this article focuses on) creating economic parity through community development. The AABLH believed that only through a comprehensive approach of education, empowerment and development could African Americans hope to diminish the insidious impacts of cardiovascular disease and diabetes on their community.

In 2000, the Community Health Councils was chosen to be one of roughly a dozen projects nationwide to receive four-year funding to implement its plan. The plan addresses not only traditional public health activities such as provider symposiums, worksite wellness programs, support groups and community wellness events, but it also assesses the nutritional resource environment with a view to creating a better quality-of-life. This focus is part of a growing initiative, as public health researchers have turned to urban planners for help with a growing number of health concerns, most prominently obesity, clearly related to the urban environment.

This project has relied on a close collaboration between health and planning researchers and community residents and organizations. Using a community-based participatory research model, the AABLH has engaged scholars from USC and UCLA to evaluate and consult with the project. The methods of the project have been to educate community residents to participate fully in the development of all instruments, procedures, implementation plans, data analysis and presentation of all findings.

We focused on the nutritional resource environment after community residents had articulated their frustration over a lack of access to healthy foods in their communities. The coalition chose to investigate the current system by performing an inventory of existing nutritional services, specifically markets and restaurants, and then use that assessment to challenge gaps in the existing system. Community organizations such as churches and social service groups were subsidized to conduct inventories in markets (and later restaurants) in their communities. The inventory was structured to investigate the availability of healthy food in local stores, and also the selections, the freshness and quality and the general level of service.

Community members inventoried 261 stores in South Los Angeles, Inglewood and North Long Beach (the “target” area), which had, on average, a 47 percent African American population and median household income of $29,237. These findings were compared to inventories of sixty-nine stores in West Los Angeles neighborhoods (the “contrast” area), which had an 8 percent African American population and a median household income of $45,917. The stores in the contrast area were inventoried by USC planning students. These inventories were then supplemented with an in-depth survey of seventy-one stores in the two comparison areas that looked more closely at the specific services offered.

The differences were dramatic. Only 2 percent of the stores in the poorer neighborhoods offered whole-grain pasta compared to 31 percent in the contrast area. Just 70 percent of the target stores offered fresh fruit or vegetables, compared to 94 percent of the West L.A. stores. The target area stores offered half the selection of produce as those in the contrast area—thirteen fruits and twenty-one vegetables compared to twenty-six fruits and thirty-eight vegetables. Furthermore, the quality of fruits and vegetables was significantly lower in the target area stores. Overall, stores in the target area were significantly less likely to offer fruits and vegetables, whole wheat pasta, nonfat milk or low-fat snacks. Contrast stores were more likely to be supermarkets (with more diverse offerings), to be cleaner and to provide better service.

These findings should suggest to community and economic development planners how hard it is for individuals in low-income neighborhoods to live a healthy life. The disparities in health conditions reflect the inequities in the nutritional resource environments. Health care advocates and educators can develop successful interventions that teach individuals the importance of eating five fruits and vegetables a day, but if they can’t buy them, or don’t want to buy brown bananas, society loses, city health services are burdened and communities are damaged.

The project is currently completing analysis of the restaurant results and moving to challenge the gaps in the market offerings. Working with other Southern California groups advocating for more equitable and sustainable food security systems, the AABLH coalition hopes to change the nutritional resource environment, providing all residents with a better chance to live a healthy life. In addition, through its innovative methodology, it is enhancing community capacity to assess other aspects of the economic environment, challenge simplistic profiles of community problems and engage researchers and officials in a dialogue about improving community life. In other words, creating a more equitable environment where residents are empowered to guide policies and programs in their communities. That sounds like planning to me.

David C. Sloane is associate professor in the School of Policy, Planning and Development at the University of Southern California and a subcontractor to the AABLH/REACH 2010 Project. The article is based on an article in the Journal of General Internal Medicine that appeared in July 2003.

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