Closing the Broccoli Gap

June 9, 2015
Source: New York Times
Author: Tina Rosenberg

Ten years ago, New York City’s Department of Health and Mental Hygiene invented Health Bucks, a program designed to help the city’s poor to eat more vegetables and fruit. City agencies and community groups distributed Health Bucks in high-poverty areas. If you spent $5 in food stamps at a farmers market, the Health Bucks program would give you a coupon for $2, which you could use or save.

The Health Bucks program was a success for the people and the markets that used it; it led more markets to accept food stamps and greatly increased food stamp spending in these markets. (In 2008 the Food Stamps program was renamed SNAP, for Supplemental Nutrition Assistance Program.) It was also a policy success.   Hundreds of cities and markets now offer double-value — or not quite double-value — coupons. Wholesome Wave, based in Bridgeport, Conn., leads a national network of 600 farmers markets in 33 states that use them.

Poor people in America tend to eat diets higher in salt, fat and sugar than richer people, and they eat less produce. This is a key reason poverty leads to illness.   Health Bucks and its variants are an exciting answer. They take aim at two of the most important reasons the poor eat this way: they lack access to fresh food, and they can’t afford it.

Local farmers also benefit. “There’s all these federal food assistance dollars, and you’re redirecting it into farmers markets and directly into the local economy,” said Lisa Tucker, co-founder and executive director of the Field & Fork Network, based just outside Buffalo, which seeks to help Western New York farmers. “Programs like this bring in a whole other clientele, a whole other amount of revenue. These types of programs are helping markets stay viable and long-term.”

But there’s a built-in limitation. Between 2009 and 2013, the amount of SNAP benefits used at farmers markets has nearly quintupled. Still, that is only .02 percent of total SNAP use — that’s one five-thousandth.

A farmer’s market in Detroit.Credit Carlos Osorio/Associated Press

New Yorkers were the biggest users of SNAP at farmers markets, followed by residents of Detroit, which is a national leader in urban agriculture and community food systems. One organization that has contributed (there are many) is the Ann Arbor-based Fair Food Network. It works with farmers markets to run its own branded version of Health Bucks, Double Up Food Bucks — and in the last three years, with more than just farmers markets. “I don’t see farmers markets as the solution,” said Oran Hesterman, president and chief executive of the Fair Food Network. “For us to imagine we can really scale up a Double Up program solely with farmers markets is a real mistake. We have to figure out how to do this well in retail grocery stores, where most people get most of their food.”

In 2013, the group worked with three independent grocery stores in Detroit to run a Double Up Food Bucks program from July through October. A SNAP customer who spent $10 on fruit and vegetables received a $10 gift card to spend on Michigan-grown produce. The next year, four new Detroit stores started the program, along with two groceries in Western Michigan.

In April, the Fair Food Network got a $5.2 million grant from the Food Insecurity Nutrition Incentive, a new program inside the Department of Agriculture, which also runs SNAP. The FINI program announced $31 million in grants to organizations testing different strategies to help SNAP beneficiaries eat more produce. Each recipient must match the grant money from other sources.

Wholesome Wave and Fair Food both received large grants. Fair Food’s money will go toward putting the program in more grocery stores — 20 stores in Michigan by August, and a total of four in Kansas City, Mo. and Kansas City, Kan.

Cracking the grocery store is not simple. “You go to a farmers market and in your head you’re thinking ‘produce,’ ” said Hesterman. “In a grocery store you’re thinking of everything from laundry detergent to breakfast cereal to produce. To encourage shoppers to slow down enough to realize there’s something special happening in the produce section takes work.”

One challenge for grocery stores is logistical: how to process the transactions. Farmers markets use tokens — about as low-tech as you can get. Part of Fair Food’s work will be to find some techno-fixes apt for grocery stores.

Another issue is seasonality — a factor for any program that promotes locally grown food. “We’ve seen that by the third month or so, people are getting used to it,” said Auday Arabo, president of Michigan’s independent grocers association, the Association of Food and Petroleum Dealers, which worked closely with Fair Food. “But by the fourth or fifth month, it’s over.”

The pilot programs run by Fair Food Network and elsewhere show that takeup rates are far lower in grocery stores than in farmers markets. In 2013, the program’s first year, 43 percent of Double Up Food Bucks earned in grocery stores were redeemed. The next year, the rate rose to 57 percent.

That might seem less than impressive, but it was far better than the rate in Minnesota, which tried its own version, called SNAP+, in three grocery stores in 2013. Jamie Pfuhl, president of Minnesota Grocers Association, said that program had an 8.5 percent response rate.

“It wasn’t up to what we hoped for,” said Jim Almstead, who runs Almstead’s Fresh Market in Crystal, Minn. People were supposed to get the coupons in the mail, but few brought them in. The store also handed them out. “Cashiers pushed it — go back and buy a package of carrots and we’ll give you a certificate,” Almstead said.

And what happened?

He paused. “Sometimes people went back and bought a package of carrots.”

The program was artisanal. Handwritten coupons were manually logged in. “We had signage at stores, but still, it was a very crude program,” said Pfuhl. Users had to go to the customer service desk to redeem their coupons, which was cumbersome. The county’s SNAP services office “needs to be working with these participants when they have one-on-one time with counselors,” she said. “It’s hard to educate them at the storefront.”

One way of looking at this is that people are throwing away money. And perhaps some shoppers really don’t care about healthy food. But there’s another perspective: Food Bucks are a form of coupons. Food Bucks in Minnesota and Michigan should do better than coupons, because they provide free food, not discounted food. But coupons in general have a dismal redemption rate; Pfuhl said normally only 1 to 2 percent.

Thinking of Food Bucks as coupons is useful, because you then treat the program as a product. Nothing sold in a grocery store — or anywhere else, for that matter — flies off the shelves by itself. Everything needs to be marketed, advertised, highlighted and explained. We assume this for commercial products. It’s even more true if you’re trying to persuade people to do something they don’t already want to do, which is generally the case with health messages. But “if you build it they will come” — the notion that you just need to utter a good idea, not sell it — still reigns in public health, and that’s dangerous.

Fair Food doesn’t fall into that trap. It’s the only Food Bucks program that’s statewide, and it focuses on growth, with central coordination and a consistent design and brand. It is essentially trying to be the Safeway of Food Bucks programs, not an independent store. Uniformity makes communication about the program easier, with SNAP beneficiaries and with others. “If we had a consistently branded program that could go across the country, it could pick up more steam in terms of grocers understanding it, local funders supporting it and policy makers seeing it as a solution,” Hesterman said.

Uniformity also makes the program easier to evaluate. Collecting good evidence is simpler if you can compare, umm, apples to apples.

Fair Food also made useful partnerships. The AARP Foundation, which has a big anti-hunger program, provides volunteers to hang out in grocery store produce departments, promote the program and answer questions. The independent grocers association is another key partner. Perhaps its biggest contribution has been counseling its members to be patient. “It’s not a huge economic windfall right now,” Arabo said of Double Up. “It hasn’t been advantageous, but we do believe it’s the future. We’re telling retailers: ‘you’re getting in early, so you’re going to be an expert.’ We have people waiting in line to be part of the program.”

This year, Double Up Food Bucks will run longer, until December 1. Since there is very little Michigan produce available at that time of year, the program is making a switch: Customers will have to earn Food Bucks buying Michigan produce, but will be able to spend them on any produce. They can save the Food Bucks and spend them on apples, squash or onions in November.

The Fair Food Network isn’t the only organization trying to make Food Bucks work in grocery stores. The AARP Foundation, which won a $3.3 million grant from FINI, is working with the Kroger grocery chain to put a program into 22 Kroger stores in Tennessee and Mississippi. When SNAP users (of any age) spend $10 on produce, they will get a coupon printed with their purchase receipt for half off their next $10 produce purchase. The program will start in September and go year-round.

“We’ll have a footprint in the produce section,” said Maggie Biscarr, the program manager of the hunger impact area of the AARP Foundation. “We’ll brand our program, have a little kiosk, and have volunteers staffing the kiosk to talk about the program.” AARP is also planning a direct-mail campaign to people over 50. “Our brand is strongly recognized,” said Biscarr.

The largest program will start in the next few months in Washington. The state’s health department received FINI’s biggest grant, $5.86 million to work with Safeway to put Food Bucks into the chain’s 168 Washington stores at once. The program will be year-round and will include frozen and canned fruits and vegetables that contain no added sugar or salt.

Safeway plans to try different kinds of coupons, discounts and marketing methods. “Including all the stores in our state allows us to test different promotions to determine how we were best able to help increase produce purchases,” Sara Osborne, public and government affairs director of Safeway in Washington, wrote in an email.

These three programs are using strategies that can help small programs grow: Partner with government. Go to where your customers already are. Gather evidence and evaluate. Brand and market like a for-profit. Piggyback on existing organizations with big reach.

Small is beautiful, but big is mandatory. “At the end of the day,” said Hesterman, “if this is only a small pilot in a few places we can feel good about, we’re not doing what we have to do.”

First posted at New York Times on June 5, 2015.
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