Anne Palmer

Food Systems and Public Health Disparities.

The United States has set a national goal to eliminate health disparities. This article emphasizes the importance of food systems in generating and exacerbating health disparities in the United States and suggests avenues for reducing them. It presents a conceptual model showing how broad food system conditions interplay with community food environments—and how these relationships are filtered and refracted through prisms of social disparities to generate and exacerbate health disparities. Interactions with demand factors in the social environment are described. The article also highlights the separate food systems pathway to health disparities via environmental and occupational health effects of agriculture.

A Framework for Understanding Grocery Purchasing in a Low-Income Urban Environment

Research demonstrates that food desert environments limit low-income shoppers’ ability to purchase healthy foods, thereby increasing their likelihood of diet-related illnesses. We sought to understand how individuals in an urban American food desert make grocery-purchasing decisions, and specifically why unhealthy purchases arise. Analysis is based on ethnographic data from participant observation, 37 in-depth interviews, and three focus groups with low-income, primarily African American shoppers with children. We found participants had detailed knowledge of and preference for healthy foods, but the obligation to consistently provide food for their families required them to apply specific decision criteria which, combined with structural qualities of the supermarket environment, increased unhealthy purchases and decreased healthy purchases. Applying situated cognition theory, we constructed an emic model explaining this widely shared grocery-purchasing decision process and its implications. This context-specific understanding of behavior suggests that multifaceted, system-level approaches to intervention are needed to increase healthy purchasing in food deserts.

The role of partnerships in U.S. Food Policy Council policy activities.

Food Policy Councils (FPC) help to identify and address the priorities of local, state, and regional food systems with the goal of improving food systems through policy. There is limited research describing FPCs’ strategies for accomplishing this goal. As part of a larger study examining FPC policy efforts, this paper investigates the role of partnerships in food systems policy change. We conducted interviews with representatives from 12 purposefully selected FPCs in the United States and 6 policy experts identified by the selected FPC representatives to document and describe their policy work. One theme that emerged from those interviews was the role of partners. Interviewees described a range of partners (e.g., stakeholders from government, business, and education) and credited FPC partnerships with advancing their policy goals by increasing the visibility and credibility of FPCs, focusing their policy agenda, connecting FPCs to key policy inputs (e.g., local food community knowledge and priorities), and obtaining stakeholder buy-in for policy initiatives. Partnerships were also described as barriers to policy progress when partners were less engaged or had either disproportionate or little influence in a given food sector. Despite these challenges, partnerships were found to be valuable for FPCs efforts to effectively engage in the food policy arena.

Process Evaluation of a Comprehensive Supermarket Intervention in a Low-Income Baltimore Community

Supermarket-based interventions are one approach to improving the local food environment and reducing obesity and chronic disease in low-income populations. We implemented a multicomponent intervention that aimed to reduce environmental barriers to healthy food purchasing in a supermarket in Southwest Baltimore. The intervention, Eat Right-Live Well! used: shelf labels and in-store displays promoting healthy foods, sales and promotions on healthy foods, in-store taste tests, increasing healthy food products, community outreach events to promote the intervention, and employee training. We evaluated program implementation through store environment, taste test session, and community event evaluation forms as well as an Employee Impact Questionnaire. The stocking, labeling, and advertising of promoted foods were implemented with high and moderate fidelity. Taste test sessions were implemented with moderate reach and low dose. Community outreach events were implemented with high reach and dose. Supermarket employee training had no significant impact on employees’ knowledge, self-efficacy, or behavioral intention for helping customers with healthy purchasing or related topics of nutrition and food safety. In summary, components of this intervention to promote healthy eating were implemented with varying success within a large supermarket. Greater participation from management and employees could improve implementation.

Interviewing Baltimore Older Adults About Food System Change: Oral History as a Teaching Tool

Urban food systems have changed considerably over the past half century. Older adults’ descriptions of place-based, personal food system history can help inform student learning and may contribute to expert understanding of food system change. Structural and social shifts in food purchasing and consumption contribute to diet-related disease and loss of historical food cultures in cities. Modern efforts to improve food systems are rarely informed by history, despite the potential benefits. Students performed oral history interviews with Baltimore older adults. Transcripts were analyzed using an inductive grounded theory approach. Interviewees described a shift from food they perceived as natural and healthy to food seen as lacking freshness, with additives and poor flavor. Many mistrusted the food industry including retailers. Some emphasized benefits of modern changes such as reduced preparation time. Despite low incomes, interviewee concerns went well beyond food prices. We describe and reflect on insights from the oral histories, while presenting a case study of the use of oral history in graduate education. To our knowledge, this is the first paper describing oral history with older adults focused on the food system.