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Eating healthy in food deserts: Many receiving assistance struggle

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PHOENIX – After a brief walk to the bus stop, her pregnant 20-year-old daughter and 1-year-old grandson in tow, Tina Zamora rides three miles to purchase produce, meat and pasta at the grocery store.

The bus drops them across the street from Pro’s Ranch Market, a bustling south Phoenix store where Zamora spends some of the $519 she receives each month in Supplemental Nutrition Assistance Program benefits, formerly referred to as food stamps.

After buying $65 worth of groceries, the family has to wait 45 minutes for the store’s free shuttle – it takes shoppers home but not to the market – to save a few dollars on a bus trek back.

Zamora’s grandson, Julian, sits patiently in the car seat drinking Sierra Mist – purchased with SNAP benefits – from his bottle as what could have been a 20-minute shopping trip by car turns into a two-hour outing.

She makes this journey twice monthly, using her SNAP benefits to support four adult children and seven grandchildren.

“It’s hard,” she says. “It’s very hard.”

If she can’t afford bus fare, she walks. But if she doesn’t have time to travel that long distance, she has to rely on the convenience store or small market in her neighborhood for essentials like milk and eggs. That means fewer options and higher prices.

“There’s a little store right here, right in the corner, but it’s too expensive,” Zamora said. “We can go and get … four, five tomatoes. They’re like $5.”

Zamora is one of 700,000 Arizonans who live in what the U.S. Department of Agriculture terms a food desert, or a low-income area that lacks immediate access to healthy, affordable food. Of this group, 21 percent are considered both low access, or far from a large grocery store, and low income.

Experts and advocates say it’s especially challenging when those receiving SNAP benefits – there are more than 1 million of them in Arizona – live in areas without convenient access to healthy food.

The Arizona Department of Economic Security dispenses tens of millions of dollars in federal SNAP funding each month – $145 million in October 2011, for example.

Arizona’s recipients spent 17.3 percent of these benefits at convenience stores during the 2009 fiscal year, according to a report released in February 2011 by the USDA’s Food and Nutrition Service. Often that’s the only choice for those unable to leave food deserts to shop.

Adrienne Udarbe, community programs manager in the Bureau of Nutrition and Physical Activity at the Arizona Department of Health Services, said the state faces the challenge of ensuring that low-income families have access to food, but it’s also trying to figure out how to connect them with healthy selections.

“When it comes to hunger issues, there is one point where you want to ensure that these families are at least just getting their basic needs met in terms of any calories versus going hungry at all,” Udarbe said. “But, in addition to that, we also know that at the same time that’s going to create illnesses and chronic disease and problems with diabetes for them, which are going to be skyrocketing health costs as well.”

U.S. Rep. Ed Pastor, D-Phoenix, said that even with assistance from the government and community groups many Arizonans face a daily struggle to locate healthy and inexpensive food.

“There’s never enough help,” Pastor said in a phone interview. “The reality is, today people are going hungry.”

Food deserts

Zamora lives in Marcos de Niza, a neighborhood made up of the 374 public housing units in an area referred to as Central City South Phoenix. Like several other neighborhoods in this section of the city, it is home to thousands of low-income residents who receive government assistance.

Sixty percent of Arizona’s 153 food deserts are in urban areas. In Phoenix and Tucson, most are in poorer areas south and west of downtown.

The Food Desert Locator, an interactive map produced by the USDA’s Economic Research Service, shows which sections of the state lack the supermarkets and large grocery stores offering items like fresh produce and whole grains.

According to the Healthy Food Financing Initiative, a partnership of the USDA, Treasury Department and Health and Human Services Department, urban food deserts are usually more than one mile from a supermarket or large grocery store, and for rural areas large stores are more than 10 miles away.

Associated with census tracts – subdivisions determined by population characteristics, economic status and living conditions – the food deserts range from relatively small areas within cities to vast, sparsely populated areas of rural Arizona. For example, most of the northeastern portion of the state, which includes large swaths of the Navajo and Hopi reservations, is considered a food desert.

Limited options

In cities built with automobiles in mind, even SNAP beneficiaries who don’t live in food deserts can struggle to get to stores selling affordably priced, nutritious food.

Gloria Espinoza, a SNAP recipient who receives $478 per month for her family of six, said grocery shopping in her South Tucson neighborhood is a constant struggle because the closest full-service grocery store is seven blocks away from her house.

About half of the residents of the one-square-mile community located along the Union Pacific Railroad are below the poverty line, according to the 2010 U.S. Census Bureau.

Espinoza’s family doesn’t have a car, so she either walks almost a mile to the grocery store and back with her four children – even in the triple-digit summer heat – or she shops for essentials like canned vegetables, juice and bottled water at the dollar store a short walk from her home.

“The only vehicle I have is my legs,” Espinoza said.

Dollar stores like the one Espinoza frequents, as well as convenience stores, generally provide the minimum requirements needed to be certified as SNAP vendors, which includes carrying some type of protein, dairy, produce and grain purchased for home preparation and consumption.

These requirements can limit options for families because approved items include soda, snack crackers, pudding, popcorn and other products that don’t necessarily meet dietary needs.

Christopher Wharton, an assistant professor at ASU’s School of Nutrition and Health Promotion, said nutrition is a low priority for some stores that accept SNAP benefits.

“There are no nutrition requirements related to SNAP approval, so in other words you can carry whatever foods you want as long as you have some selections in those categories,” Wharton said.

Punam Ohri-Vachaspati, an associate professor at Arizona State University’s School of Nutrition and Health Promotion, said limited access to grocery stores in low-income areas causes many families to shop at convenience stores, especially because the stores are often more prevalent in these areas.

“When the access is very poor, frequency of purchases at these markets is impacted also,” Ohri-Vachaspati said. “People may do a monthly shop at the large supermarket, and then for all other small purchases they may go to their local convenience store.”

The convenience stores, dollar stores, gas station mini markets, pharmacies and liquor stores on the state’s SNAP-approved list pose yet another problem: Value.

Ramona Beltran, a senior research fellow with the Center for the Study of Health and Risk Behaviors at the University of Washington, said the value drops considerably when consumers shop at smaller markets.

“On average food cost in smaller or medium-sized grocery stores is about 20 percent more compared to larger supermarkets,” Beltran said in a phone interview.

Jean Daniel, public affairs director for the USDA’s Food and Nutrition Service, said she has little concern about SNAP recipients shopping in convenience stores because most use their benefits elsewhere. She noted that 85 percent of SNAP benefits are spent at grocery stores or markets.

Daniel said the USDA provides nutrition education for SNAP recipients to ensure they know how to shop for healthy items on a limited budget, adding that the program succeeds at getting low-income families back on their feet.

“It’s an important investment,” she said.

Tim McCabe, president of the Arizona Food Marketing Alliance, said the retail food industry has embraced consumers’ desire for healthy options and that newer options, such as Walmart’s Neighborhood Market and grocery aisles added to Target stores, are more prevalent now than in the past.

“The healthy choices to eat are very available,” McCabe said in a phone interview. “You don’t see it just in supermarkets; you also see it at convenience stores now.”

A rural problem

On the first Thursday of every month, St. Mary’s Food Bank Alliance delivers produce to a community center in Gila Bend, supplying as many as 400 residents with free, healthy food.

Diane Dempsey, social services director for the Gila Bend Community Action Program, helps distribute the food to families who share the strain of living in a food desert.

“St. Mary’s is a big blessing,” she said. “I don’t know what our community would do without them.”

This entire community is in a food desert stretching across hundreds of square miles of desert southwest of the Valley. About a quarter of Gila Bend’s residents are below the poverty line, according to the U.S. Census Bureau.

For those unable to get to Buckeye, 30 miles north on U.S. 85, options for using SNAP benefits are limited to a truck stop, gas station, two dollar stores and a small market that was recently closed for a month.

In many rural areas across the state, people have to travel long distances to buy healthy, affordable food, a problem that’s magnified for the low-income families and those who lack reliable transportation.

University of Washington’s Beltran said this situation is pretty common across the country.

“Typically in rural, low socio-economic status or urban socio-economic status areas, those major supermarkets won’t locate there,” Beltran said. “So there will be just the convenience store or the small to medium-sized store without the healthy choices and with the higher costs. But when that’s it, that’s what you have to work with.”

McCabe, with the Arizona Food Marketing Alliance, said large grocery store chains don’t base locations on the socio-economic status of areas.

“It doesn’t matter whether you’re in a lower-income area or a really high-income area; it’s just, will the people that live in that area shop in that store and give you enough return to justify being able to buy the land or lease the building or pay the employees?” he said.


Several states have proposed limiting unhealthy items SNAP recipients can purchase with their benefits.

Earlier this year, for example, New York requested permission to conduct a pilot program in New York City that would remove sugar-sweetened beverages from the SNAP-approved list. It was rejected by the USDA in August.

Eight other states have made similar requests without gaining approval.

Daniel, the USDA Food and Nutrition Service’s public affairs director, said it would be difficult to administer a program like the one suggested in New York.

“If you limit food items – certain food items – how do you define them? What standards do you set?” she said in a phone interview.

Steve Meissner, a spokesman for the Arizona Department of Economic Security, which dispenses SNAP benefits to recipients throughout the state, said DES is aware that some recipients spend SNAP benefits on unhealthy foods.

“Unfortunately we don’t have the authority to tell people what to eat,” Meissner said in a phone interview. “We’re not the food police.”

Daniel said the USDA would rather educate recipients about how to obtain nutritious food with their benefits. In 2010, the agency launched a Healthy Incentives Pilot in Hampden County, Mass., providing credits to SNAP recipients’ accounts if they purchase fruits, vegetables or whole grains.

“It’s kind of like getting a discount if you buy fruits and vegetables,” Daniel said.

More than 20 states have programs matching SNAP purchases at farmer’s markets up to a certain amount.

Designing solutions

When she opened Phoenix Public Market, the first grocery store in downtown Phoenix in 30 years, owner Cindy Gentry said it was important that her store accept SNAP benefits so recipients would have access to healthy food.

“The idea is to integrate,” Gentry said. “Instead of it being them and us, make it normal for people of all backgrounds to mingle and for people of fewer resources to get their food in a normal way – in a normal place.”

Now, as founder of the Community Food Connections, a nonprofit organization that provides healthy food to underserved communities, Gentry said she would like to see something akin to the days when vendors brought a variety of foods into neighborhoods on pushcarts. In this case, it would be mobile food markets that provide items like fresh produce and whole grains to those who don’t have ready access to them.

“That’s a solution,” Gentry said. “That creates jobs, it brings food, it’s mobile, it’s replicable and it’s fun. That would be an answer to food deserts without having to put up the infrastructure of a grocery store.”

Hers and other groups around Arizona are developing community-based solutions to food scarcity in poorer areas.

The Primavera Foundation has a community garden at one of the transitional housing units it operates in Tucson to teach residents how they can to grow their own produce when they move to permanent housing.

Emma Stahl-Wert, the foundation’s garden coordinator, said her goal is introducing fresh food to low-income individuals who need nutrition assistance.

“But also, when you’re growing your own food there’s then a learning step of, ‘What do I do with this vegetable?’” she said.

ASU’s Wharton received a grant from the USDA in 2009 to provide eight farmers markets around Arizona with wireless Electronic Benefits Transfer terminals, allowing SNAP recipients to purchase food there. He’d like to see that expand.

“Farmers markets would be an ideal place for people to redeem some of their benefits because they get whole foods there – fruits and vegetables, fewer processed, packaged foods,” Wharton said.

ASU’s Ohri-Vachaspati, who researches childhood obesity, said communities and consumers should lobby for healthier food choices in existing stores.

“I think what we really need is a public campaign to get people on board and say, ‘These changes are critical,’” Ohri-Vachaspati said. “‘These changes are critical from the point of view of the society, but they make a lot of economic sense.’”

Udarbe said the Arizona Department of Health Services’ efforts to educate recipients of public assistance about the benefits of healthy eating hold promise for the broader community.

“All members of the community should get involved and have a say because this has tremendous economic and health benefits for everybody,” Udarbe said. “It’s not just for the WIC (Women, Infant and Children) families; it’s not just for the SNAP families. It’s for everybody in Arizona to get engaged in creating healthy community design.”