Creating Healthy Corner Stores: An analysis of factors necessary for effective corner store conversion programs

Jessie Azrilian, Allison Kwan, Mark Linthicum & Julia Wolfson May 2012

A USC Sol Price School Practicum Report Prepared for the Los Angeles Food Policy Council

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Table of Contents I.

Executive Summary!!!!!!!!!!!!!!..!!!!!!!.!!!!!1

II.

Why Corner Stores?................................................................................................6 Food Environments Are Unequal!!!!!!!!!!!!!!!!!!...!!6 Health Consequences of Food Access Disparities!!!!!!!!!!!.!!.7 Study Focus: Healthy Food Access Through Corner Store Conversion!!!...!7

III.

Methodological Overview!!!!!!!!!!!!!!!!!!!!!!.!..10

IV.

Designing Healthy Corner Stores.........................................................!!!!..13 Motivations Matter: Why Corner Store Conversions?!!!!!!!!!!!!13 Design Matters: Strategies for Achieving Objectives!!!!!!...!!!!!..14 Implementation Matters: Supporting Success and Sustainability!!!!!.!...19

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CMC Program: A South LA Case Study!!!!!!!!!!!!!!!!!..29 Implementation Matters: What can go wrong? !!!!!!!!!!!!..!!30 What were the Consequences for the CMC Program?.........................................34 Lessons Learned from the CMC Program!!!!!!!!!!!!!..!!.!37

VI.

Recommendations!!!!!!!!!!!!!!!!!!!!!!!.!!!..39

VII.

Conclusion!!!!!!!!...!!!!!!!!!!!!!!!!!!!!!.43

Works Cited!!!!!!!!!!!!!!!!!!!!.!!!!!!!!!!!!.44 Appendix A: Detailed Methodology!!!!!!!!!!!!!!!!!!!!!...!50 Appendix B: CMC Program Description!!!!!!!!!!!!!!...!!!!!!56 Appendix C: CMC Store Profiles!!!!!!!!!!!!!!!!!!!!!!..!.62 Appendix D: Model Practice Program Attribute Tables!!!!!!!!!!!!!.!70

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TABLES AND FIGURES Figure 1: South LA & LA County Demographic Comparison!!!!!!!..!!!!.!!.8 Figure 2: Logic Model!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!11 Table 1: Common Program Elements!!!!!!..!!!!!!!!!!.!!!!!....16 Table 2: Corner Store Elements!!!!!!!!!..!!!!!!!!!!!..!!!!.23 Figure 3: Locations of Stores Participating in CMC Program...!!!!!!!..!!!!!27 Figure 4: CMC Program: Two Funding Streams!!!!!!!!!!!!...!!!!..!.28 Figure 5: CMC Program Timeline!!!!!!!!!!!!!!!!!!!!!!!!!29 Table 3: Lessons Learned!!!!!..!!!!!.!!!!!!!!!!!!!!!!.!38 Table 4: Recommendations!!!!!!!!!!!!!!!!!!..!!!!!!!.!..39 Figure 6: Complete Logic Model!!!!!!!!!!!!!!!!!!!!!!!!.....51 Table 5: Model Practices!!!!!!!!!!!!!!!!!!!!!!!!!!!!..70

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EXECUTIVE SUMMARY

This report focuses on the efficacy of corner store conversion programs as a means of increasing the availability of healthy food. Through a comprehensive review of model practices from across the nation, and an in-depth formative evaluation of the recently implemented Community Market Conversion (CMC) Program in South LA, the study team developed recommendations to the Los Angeles Food Policy Council on how they can best incorporate corner store conversions into their agenda of making “good food” available for all. While corner store conversions remain unproven on public health grounds, they can be effective, if implemented well, at addressing equity concerns raised by disparities in food environments between neighborhoods. Can Corner Store Conversion Improve Unhealthy Food Environments? Low-income and minority neighborhoods typically have limited access to fresh produce, fewer full service grocery stores and sit-down restaurants, and more corner or liquor stores and fast food restaurants. The combination of a lack of fresh produce and the ready availability of processed foods and high-fat take-out meals has been linked to higher rates of obesity and diet-related illnesses such as diabetes in these communities. Corner store conversion programs, which seek to increase the sale of fresh produce by local small retailers, are among the many strategies used to improve the health environment of disadvantaged neighborhoods This approach takes advantage of existing infrastructure and community businesses to increase the availability of healthy food, avoiding some of the obstacles and issues related to attracting large grocery stores. Such corner store conversion projects (also called market makeovers) have been undertaken in many cities, including San Francisco, Baltimore, Philadelphia, Detroit, and New York City. Los Angeles is host to several such programs including the focus of this report, the Community Market Conversion Program in South LA. Even as corner store conversions have become more popular, surprisingly little research exists that demonstrates the effect of these interventions on local communities, particularly over the long term. This report attempts to illuminate the motivations and arguments for implementing corner store conversion projects, how they are designed to meet their goals, and how best to ensure program success, sustainability, and scalability. Scope and Methodology This report was created at the request of the Los Angeles Food Policy Council (LAFPC), which seeks to incorporate corner store conversions as part of their strategy for creating a food system that is “healthy, affordable, fair and sustainable.”

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The project goal is to create actionable recommendations for the LAFPC regarding how best to support the four stores who participated in the recent CMC Program, as well as how most effectively to support corner store conversions in Los Angeles generally. The study combined a review of literature on health disparities and food access policy with a model practices study and a formative evaluation of the South LA CMC Program. The research team conducted 36 semi-structured interviews with national and local experts on food policy as well as policy stakeholders and the owners of the four stores involved with the CMC program. The research focused on factors that facilitate and impede the successful implementation of market makeover projects such as the program attempted in South LA. Findings Evaluation of corner store conversion programs is complicated because programs may embody different motivations – improved community health and lowered disease rates, equity issues related to access to healthy food, economic development, and communitybuilding. Differing motivations imply different assumptions about how the programs should function, which in turn have a significant impact on programmatic design and implementation. This suggests a need for clarity at the onset regarding what outcomes are sought. Many programs are primarily motivated by public health and equity arguments, and hence share common design elements that generally fall within two broad strategies: increasing supply and generating demand. First, they attempt to increase the availability of affordable healthy food by developing produce inventory in small corner stores. Second, they endeavor to generate increased demand for healthy food in the community through marketing, education, and other means. In terms of specific programmatic design elements, programs include a wide variety of activities that fall into four broad categories: community engagement; physical changes to layout or infrastructure; outreach, education, and marketing; and technical assistance for store owners. While little evidence exists to support corner store conversions as a means of improving long-term health outcomes, they can certainly be justified on equity grounds. Having more corner stores in food desert neighborhoods selling healthy food helps achieve the LAFPC’s goal of making “good food” more accessible for all. Therefore, the FPC has decided to advocate for the creation of a new corner store program to pick up where the CMC Program left off. Model practices: determinants of success. The model practice study suggests that the success, sustainability, and scalability of a program depend on several features of design and implementation. The following factors appear to increase the odds of success:

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Meaningful Community Engagement: Engaging the community throughout the program life is essential to its sustainability and to developing interest from new stores. One way to engage the communities is through youth programs and partnerships with local schools. Steering Committees and regular community meetings are also key for ongoing community involvement.

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Strategic Partnerships: Corner store conversion programs tend to include a wide range of components, from physical renovations to marketing, so it is important that programs be built on partnerships between agencies and organizations that possess the specific sets of skills, capacities, and resources that best meet all program needs. Partners may include community stakeholders, nonprofit organizations, public agencies, foundations, and universities.

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Stable funding: Funding restrictions place one of the largest constraints on the implementation of a program. Though long-term and stable funding is often elusive, it is essential that programs have a long-term plan for sustained funding.

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Strategic Store Selection: Programs need to be strategic in where they spend their resources, and only invest in stores that would advance the goals of the program, appear to be a sound investment, and have owners that are motivated and committed to the program.

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Leveraging existing policies and programs: Existing policies and programs often exist that provide unique opportunities for corner store makeover projects. By understanding existing retail requirements, WIC/SNAP requirements, and other guidelines or incentives for store owners, the efficacy of a program may be increased.

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Tiered Levels of Involvement for Stores: Complete internal and/or external renovations are not realistic on a large scale, and may not be the appropriate level of intervention for all stores. Some stores might benefit from beginning with small produce displays, participation in a joint purchasing program, or assistance with purchasing refrigeration equipment. Then, if the community demand is sufficient, and the store has sufficient motivation and commitment, a full-scale renovation may be appropriate. Because this incremental approach necessitates a lower capital investment per store, it will allow for a greater impact throughout the community.

The LA Community Market Conversion Program. The difficulty of designing for success is exemplified by the CMC Program, initiated in 2010, which incorporated many of the features found to be important in the model practice study. The program sought to integrate: large-scale façade and interior renovations for four participating stores; technical assistance and business training for store owners; outreach

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and grand opening events; and youth engagement and community participation. Several factors impeded the implementation of this design, including bureaucratic obstacles and unanticipated disruptions, most importantly the dissolution of the Community Redevelopment Agency (CRA). Thus, although the program sought to include many important design features, implementation obstacles threatened the long-term sustainability and scalability of the program. The complications created by the state’s decision to end Redevelopment – which caused all CRA contracts to be placed on hold for months and created uncertainty about whether store renovations would happen at all – disrupted the planned timing of store re-openings, which were intended to occur in March 2012. This timing coincided with the end of grant funding for outreach, education, and marketing activities. As a result, the store re-openings will occur without the support of promotion and publicity activities. Lessons learned: supporting implementation of corner store conversions in South LA. The ultimate success of any corner store program depends on a multitude of factors from the design of the program components to their implementation, the social and political climate of the community, and the economy in general. In light of this, a program that allows for a more incremental or tiered approach to conversions rather than a resource- and timeintensive large-scale renovation approach may be a better fit for South LA. A program with multiple levels of involvement may also have a greater chance of meeting the community where its current demand is, allowing for shopping and eating habits to gradually change, and has potential for a larger impact and greater chance of long-term sustained improvement to the food environment. Similar to the CMC program, the ideal corner store conversion program for South LA will combine technical assistance, community engagement and physical renovation to achieve the above goals. However, the program should be structured so that it has both greater security for the program itself and more flexibility in how corner stores can be involved. Additionally, to create true community and store-owner buy-in, the program should be developed using more of a “ground up” approach. Recommendations The recommendations fall along two lines. First, the LAFPC can support the four stores that participated in the CMC Program to help ensure their success whether or not the physical renovations proceed. Second, the LAFPC is in a unique position to support corner store conversions in South LA, and these recommendations provide a guide in how they can do that.

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Supporting the CMC Program’s Participating Stores The CMC stores may still undergo renovations, but if they do, it will be without the demandgenerating program components the CMC Program would have performed. Without activities to spur and maintain demand, it is unlikely that the stores will maintain sales of fresh produce after they receive their renovations. Thus, the stores represent an opportunity for the LAFPC to step in where the CMC Program left off. If the renovations do not take place, the LAFPC can still support these motivated store owners’ efforts to continue down the path to becoming healthy corner stores. To support the sustained sale of produce in the four participating stores, the LAFPC should: • • • •

Integrate store support into the Healthy Food Retail working group’s scope of work; Organize promotional events and develop marketing support for the four participating stores; Coordinate with existing networks including community non-profits and other businesses; Identify community champions capable of promoting the CMC stores throughout the neighborhood.

Supporting Corner Store Conversion Programs in South LA In addition to supporting the four CMC stores, the LAFPC has made creating a new corner store conversion program a priority. Using its role as an entity in the food policy community that “catalyzes, coordinates and connects” there are several actions the LAFPC can take to guide and ensure the creation of an effective and successful corner store conversion program. To support small retail interventions that serve to increase access to healthy foods, the LAFPC should do the following: • • • • •

Expand community participation, especially in low-income neighborhoods Create a Healthy Corner Store Business Association Collaborate with universities and foundations Develop strategic partnerships Focus on regional outreach in specific geographic focus areas

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WHY CORNER STORES?

In many metropolitan cities, including Los Angeles, food environments are unequal. A complex set of interrelated factors limit the access to healthy food in urban low-income minority communities. The lack of healthy food options contributes to unhealthy dietary choices, leading to negative health consequences such as obesity and diabetes. These health threats disproportionately affect low-income and minority populations. Corner store conversions – programs that aim to increase sales of healthy food in existing small markets – are seen as a promising strategy for addressing these disparities because they improve existing infrastructure as well as leverage existing policy and program structures. Food Environments Are Unequal Where individuals live determines both their food environment and, as a result, their access to healthy foods. Food environments vary considerably in: the quality and freshness of foods; retail accessibility; the mix of products sold in local shops; and the affordability of various food products. Poor and minority communities tend to have worse food environments (Powell, Slater, Mirtcheva, Bao & Chaloupka, 2007). Low-income neighborhoods not only have fewer food retailers but also experience lower quality and less variety of healthy foods (Powell et al., 2007; Andreyeva, Blumenthal, Schwartz, Long, & Brownell, 2008). Specifically, produce sold in low-income neighborhoods is usually less fresh and of lower quality (Andreyeva et al., 2008). The lack of grocery stores in poor neighborhoods has been a particular focus of food access research, but another important component of the urban food environment is the ready access to convenience/corner stores, where the main sources of profit are high calorie, low nutrition items such as candy, chips, and ice creams (Borradaile et al., 2009). These stores are more likely to be alternatives to grocery stores in low-income and minority neighborhoods; for example, there are 1.3 times as many convenience stores in low-income urban areas than middle-income areas (Borradaile et al., 2009; Powell et al., 2007). Much of the research has centered around the linkages between eating behaviors and accessibility; however, a growing body of research also highlights the important role of food affordability (LA Food Policy Expert, 2/23/2012; Darmon & Drewnowski, 2008). For instance, a study compared the availability and cost of the Thrifty Food Plan (TFP) to a set of healthier substitutes and found that the healthier plan was more expensive and would consume 25 percent to 40 percent of low-income groups’ food budgets (Jetter and Cassady, 2005). Additionally, studies have discovered that food costs are a barrier to eating more fish, whole-grain products, or produce (Darmon & Drewnowski, 2008).

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Various barriers to entry make improving the food environment of low income and minority urban communities difficult. Retailers choose to locate elsewhere because of limited land availability, strict zoning regulations, and concerns with security and profitability. This occurs in spite of the substantial spending power of inner city markets (Loukaitou-Sideris, 2010; Porter, 1996). As a result, East and South Los Angeles have far fewer access points to healthy food retailers when compared to West Los Angeles (Lewis et al., 2005). Health Consequences of Food Access Disparities Poor dietary habits contribute to obesity rates, which have increased at an accelerating rate in recent years. Nationally, obesity, diabetes, and other diet-related disease cost the government $147 billion dollars annually in direct medical costs, and also result $141 billion in lost productivity annually (USDA, 2009; Witters & Agrawal, 2011). Obesity and other dietrelated chronic diseases such as diabetes affect the poor and Blacks and Hispanics at much greater rates than wealthier populations and Whites (Flegal, Carroll, Ogden, & Curtin, 2010; CDC, 2011). A food environment deficient in healthy foods can lead to higher rates of dietary-related problems, obesity, and diabetes (U.S. Department of Health and Human Services, 2001). The lack of supermarkets in a neighborhood can perpetuate an overweight population because corner stores and smaller grocery stores typically stock more processed foods and fewer fresh fruits and vegetables (Fleischacker & Gittelsohn, 2010; Morland, Roux, & Wing, 2006). Additionally, poor households are the most susceptible to diet-related health outcomes because they buy fewer fruits and vegetables than higher-income households (Algert, Agrawal & Lewis, 2006). Their diets also tend to be higher in fat and calories (Drewnowski & Specter, 2004). A community comparison across the nation revealed that the number of healthy products in stores is connected to the healthfulness of people’s diets (Cheadle et al., 1991). Lower rates of diet-related diseases occur in neighborhoods where healthy food retailers outnumber food stores that do not sell fresh produce (Larson, Story, & Nelson, 2009). Another study concluded that obesity rates were lower for Californians and New Yorkers who lived in areas where there were more healthy food retailers than fast food and convenience stores (Rundle et al., 2009). Study Focus: Healthy Food Access through Corner Store Conversion For some years, policy actors and advocates have sought to improve food access by attracting new food retailers, and especially large grocery stores, to underserved communities (USDA, 2009). Research suggests that this approach can have positive outcomes. A multi-state study observed that produce consumption increased for both African Americans and Whites as more supermarkets appeared in a census tract (Morland, Wing, & Roux, 2002). Another study discovered that locating a new grocery store in a lowincome area could lead to a three pound weight decrease (Chen et al., 2009).

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South Los Angeles In Los Angeles County, the link between unhealthy food environments and poor dietary habits appears to be particularly acute in Southern Los Angeles (see Figure 1). For example, only 12.7 percent of South Los Angeles residents consume five or more servings of fruits and vegetables a day, compared to more-affluent West Los Angeles (22.7 percent) and Los Angeles County overall (14.7 percent) (LADPH, 2009). In Los Angeles County, South Los Angeles has the highest rates of obesity and poverty (LADPH, 2009). Figure 1.

While incentivizing supermarket construction may help to alleviate food disparities, the approach draws criticism from some quarters. For example, Jung (2011) and others suggest that large chain retailers do not create sufficient economic benefits for local communities in comparison to what has been promised by such retailers. There is also concern that the scale economies of large grocery stores allow lower prices, which in turn threaten the economic viability of existing small businesses in the community. Attraction of large retailers may increase the variety of products available overall, but this may come at the expense of local businesses that are more invested in community life. There has been increased attention to the “conversion” of existing retail locations to healthy food retail. Most often, this approach focuses on conversion of corner liquor stores, where a combination of physical store makeovers, promotion, and technical assistance allows store owners to increase sales of healthy food (Jetter & Cassady, 2009). Corner store conversion programs have been introduced in a number of cities. Notable examples include

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Philadelphia, Baltimore, Detroit, Washington DC, and New York City. In recent years, new corner store conversion programs have emerged in several Los Angeles neighborhoods, building on the work of existing organizations such as Community Services Unlimited. For example, the California Endowment’s Healthy Eating, Active Communities (HEAC) initiative supported store transformations in South Los Angeles and Baldwin Park. In East Los Angeles, UCLA is currently working on a corner store conversion study funded by the National Institutes of Health. Because these are relatively new interventions, there is limited research on the long-term impacts of small market conversion on consumption patterns and health outcomes (Academic Expert, 12/12/2011; Academic Expert, 2/10/2012). Some emergent studies are encouraging, however. For example, a corner store conversion program in Baltimore increased the likelihood of customers to engage in healthy food preparation and eating (Gittelsohn et al., 2009). Another study in Sacramento revealed that there was demand for produce, as customers came into the converted corner store specifically looking to buy fresh fruits and vegetables (Jetter & Cassady, 2009). This study contributes to understanding the potential for, and challenges facing, market makeover programs with a particular focus on the implementation of a pilot program initiated by the Los Angeles City Community Redevelopment Agency (CRA). The CRA’s Community Market Conversion (CMC) program couples a physical renovation loan program with a pilot program of public outreach, marketing and technical assistance for four stores in South Los Angeles. The CMC program was piloted during the past year, and provides a valuable case study through which to explore the challenges in implementing corner store makeover projects in general and in South LA, specifically. The CMC program has encountered an array of implementation obstacles, not least of which was the dissolution of the agency with implementation oversight. By focusing on the challenges encountered by this pilot program, this study aims to inform future program development. The broader goal of this study is to advance the development of effective and sustainable food policy by providing an empirical analysis of corner store conversions as programmatic interventions. This study attempts to systematically assess the link the motivations, design, and implementation of market conversion programs and their success and sustainability, with a particular focus on the context of South Los Angeles. The primary research questions addressed in the report are: 1. What factors affected the implementation of the CMC program and how did these affect CMC’s ability to meet its stated goals? 2. What components contribute to a sustainable corner store conversion program?

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METHODOLOGICAL OVERVIEW

Numerous and varied corner store conversions have been implemented in metropolitan areas across the country in recent years in an attempt to mitigate growing negative health outcomes resulting from poor food resource environments. However, drawing a direct causal link between these policy and program interventions and outcomes is problematic, and therefore assessing the effectiveness of different approaches is difficult. This study employs a two-pronged approach to assess the current state of programmatic interventions that increase the prevalence of healthy corner stores. The primary goal is to create actionable recommendations for the Los Angeles Food Policy Council (LAFPC) regarding support for policies and programs that increase access to healthy food in South Los Angeles. To do this, the study objectives were to: 1.

Perform a formative evaluation of factors that facilitated and impeded successful implementation of the CMC pilot program.

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Identify and analyze model healthy corner store programs from around the United States to glean insight into implementing a healthy small retail strategy in Los Angeles.

Appendix A provides a more detailed discussion of the study methodology and considers the strengths and limitations of the research design. The remainder of this section provides a methodological overview. Review of Model Practices: The model practices study drew on internet research and experts in the field to identify exemplar programs that: increase availability of fresh produce in small retail stores; operate in urban communities similar to South LA in terms of demographics; and had been started at least one year earlier. Sixteen model programs were identified that met the three criteria and qualified for further study. Next, the team performed further research online, from academic literature or studies about the programs, program documents and through a total of ten interviews with program staff. After collecting data on all of the model programs, the authors analyzed their program components, implementation, funding structure and sources, evaluative methods, and, to the extent possible, any associated outcomes. Formative Evaluation of CMC Pilot Program In order to consider “street level” challenges to implementation of effective market makeover programs, the team also conducted a formative evaluation of the CMC Pilot Program. Occurring during the development or improvement of a program, formative evaluation is a technique used to assess programmatic development, often focusing on the process of implementation. The elements evaluated included: strengths and weaknesses of the program inputs; environmental factors that impact implementation; and opportunities for improvement. The formative evaluation of the CMC pilot program was based on a

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qualitative methodological approach. The study team conducted 23 interviews with a variety of food policy experts in Los Angeles, the CMC program creator, CMC program coordinators, and staff at several CMC program partner organizations. The team also conducted interviews with the 4 store owners participating in the pilot. Using information obtained through these interviews, program documentation, and literature reviews, the research team evaluated the implementation of the program inputs, contextual factors that influence the CMC program, and to the extent possible, the program’s potential to achieve its desired outcomes. A logic model for the CMC program served as a tool to structure and guide the analysis, a simplified version of which is included below. For the full logic model, see Appendix A. Additionally, detailed profiles of each of the four stores currently participating in the CMC pilot program were developed, which further informed the analysis (see Appendix C).

Figure 2: Logic Model

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Evaluative Criteria Assessing the achievements of the corner store conversion approach raises the important issue of how to define program success. The literature review and expert interviews suggest that a successful corner market conversion program is one that sustainably increases the availability and purchase of affordable healthy food in low-income neighborhoods. In addition to making changes that are realistic for the individual stores to profitably maintain, a successful program should itself be scalable and sustainable. Because little scientific evidence exists regarding the impacts of corner market conversion on local consumers’ diets or health, this study had to assess programs not on outcomes, but on assessments of the programmatic inputs and processes likely to lead to success. Thus, the evaluative criteria focused on assessments of model design, the ability to be implemented and maintained over the long term, and the apparent potential of the program to reach the target population and achieve their stated goals. Methodological Considerations Due to the novelty of corner store conversion as a strategy for improving poor food environments, little data exist to perform any quantitative analysis of its effects. As a result, any evaluation of success is qualitative and depends upon information, experiences, and opinions shared by human respondents. By nature, these data are prone to error, bias, and omission. In order to provide an unbiased and accurate evaluation, the research team endeavored to include a diverse set of perspectives and experiences, especially from the expert interviews, and to cross-reference findings from the expert interviews with published work examined in the literature review.

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DESIGNING HEALTHY CORNER STORES

Corner store conversion programs seek to produce two broad categories of outputs: increased availability of healthy foods in small markets and increased demand for healthy food. These objectives are based on assumptions about cause-and-effect relationships that in turn influence design, implementation, and ultimate success. Many programs share a set of common assumptions and, therefore, similar designs. Regardless of the goals that motivate a program, certain key elements must be present in the design and implementation of a program in order to increase the probability that it will be successful, sustainable, and scalable. Motivations Matter: Why Corner Store Conversions? The motivations for corner store conversion programs vary and include concerns about public health, demand generation, economic development, and community engagement. There are some commonalities across model approaches. Early programs generally assumed that merely increasing the availability of healthy choices in the food environment would change consumption behavior. Over time, however, it has become clear that the “if you build it, they will come,” approach does not lead to sustained purchase of produce (Academic Expert, 2/10/2012). On a practical level, placing healthy food in corner stores may not change customers’ shopping habits, and in the absence of demand for healthy food, store owners will not continue to stock it. As a result, programs increasingly include features that encourage demand for healthy foods. The early focus on communities’ diet-related diseases and other health outcomes has broadened to include increasing equity, or food justice, as a motivation for corner store conversions. Low-income and minority populations tend to live in unhealthy food environments with limited access to fresh produce, fewer healthy food options, more fast food, and more liquor stores. From a food justice perspective, increasing the healthiness of food options in these communities is a moral and ethical action to take, regardless of economic efficiency. The food justice argument is straightforward: if inequity in availability of affordable healthy food is determined to be an important social issue to rectify, any solution that increases access to affordable healthy food may successfully address the issue. In recent years, corner store conversions have also been used as a tool for economic development and community self-sufficiency. Supporting small businesses in underserved communities arguably creates a positive environment for residents in the surrounding community by promoting more social interaction and helping change self-perceptions and norms amongst residents. Additionally, development efforts targeting small businesses have the potential to attract new customers and are linked to increasing property values, contributing to neighborhood jobs, and heightening business sales (Sutton, 2011; Moore, 2009).

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“Maybe the whole corner store conversion intervention just isn’t a health initiative. Maybe it should solve a different problem” -Expert 2/23/12

In addition, developing and strengthening community cohesion is an important goal of some programs. For example, Oakland’s Mandela MarketPlace sees its work with store owners as a way to help them become “better neighbors” (Expert B, 3/20/2012). Such programs approach community engagement not as means to another end but rather as an end in itself. Design Matters: Strategies for Achieving Objectives Experts interviewed for the study agree that creating sustainable changes in the food environment involves more than simply placing produce in a store. A variety of activities are required to ensure that the supply of produce is maintained. Simply increasing the supply is not enough, however – local demand for fresh produce, and specifically demand for produce from corner stores, must also be developed for healthy corner stores to succeed. In designing corner store makeovers, some activities clearly fall into supply- or demand-related categories, while others address both. These categories are discussed below. For a selection of common program components and examples from the study, see Table 1. Increasing Availability and Affordability of Healthy Foods Getting and keeping produce on stores’ shelves requires more than a simple delivery of fresh fruit and vegetables. Stores owners must be educated on where and how to purchase produce, how to store it and how to effectively display it in an appealing manner. These retail strategies vary depending on the resources available in the community, the scale of the produce display in the store, and the needs and skill level of the store owner. Common approaches include procuring produce from another community non-profit, working with community gardens and farmers markets in the area, going to large wholesale produce markets, and utilizing purveyors and distributors who deliver produce to stores and restaurants.

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Healthy Corner Store Initiative- The Food Trust Philadelphia, PA Widely recognized as the pioneer of corner store conversions, Philadelphia’s The Food Trust first began its efforts in 2004 when it developed the Healthy Corner Store Initiative The program aimed to change buying habits of individuals shopping in corner stores through education and direct marketing. The Food Trust targeted corner stores because of their abundance throughout the city, with the goal being to increase healthy food options in corner stores in poverty-stricken neighborhoods that also had the highest rates of chronic disease. While initially working with 44 stores, The Food Trust partnered with the Philadelphia Department of Public Health in 2010 to expand its network to 600 stores. Previously, the conversions occurred on a smaller scale with stores introducing four healthy products into their inventory, but with this new partnership and additional funding, stores can be incentivized to receive mini-conversions. Understanding that these corner stores will not survive without support and assistance, The Food Trust has worked with store owners to tailor their healthy inventory and developed customized training plans. Additionally, to encourage systematic change throughout the city, The Food Trust reached out to over 20 neighborhood and citywide organizations for collaboration and general support of the stores. As a result of their efforts, the Healthy Corner Store Initiative has experienced a number of successes: 83% of the stores have met the basic requirements once enrolled, 76% training acceptance rate, and 100 store conversions. Not only is The Food Trust doing work in Philadelphia, it also co-created a national Healthy Corner Store Network, promoting the benefits of corner store conversions and providing a forum and support network for similar programs.

Once produce is in the stores, the next step is to ensure that store owners know how to handle it on an ongoing basis. Technical assistance serves to develop the skills of store owners in managing new healthy inventory specifically and, in some cases, managing their business in general. Store owners with no experience in managing an inventory of perishable items may lack the skills required to limit loss of product to spoilage. In addition to knowledge and skills, stores may lack the infrastructure or equipment (for example, water connections or refrigerators) needed to store produce. In these cases, investment in basic infrastructure or equipment is critical for maintaining inventories of fresh produce.

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It should be noted that addressing supply involves not only providing more healthy food, but also ensuring quality and affordability. Even if a store is equipped with the infrastructure necessary to stock fresh produce, an abundance of high-price and/or low-quality produce coupled with a lack of sufficient demand to ensure the healthy products sell renders the equipment useless (Expert, 11/8/2011; Store Owner interviews). Affordability is an issue because smaller corner stores have trouble competing with the lower produce prices at big grocery stores, and also because fresh produce is often more expensive than other less healthy options, regardless of where customers shop. Some experts argue that merely increasing accessibility of fresh produce will have little impact on changing shopping and eating habits if those products are not also made more affordable (Expert, 2/2/2012).

Table 1: Common Program Elements Common Program Component

Program

Example of practices

Community Engagement

Southeast Food Access (San Francisco)

Project developed from community-based participatory research model that engaged local youth in store assessments, and young professionals in the community continue to drive assessments, interact with the store owners, and meet with the community

Infrastructure/ Store Layout Improvements

Detroit FRESH (Detroit)

Provided equipment such as produce scales and refrigeration; helped spruce up the interior by adding in more shelving, rearranging items; an exterior store mural

Outreach, Education, & Marketing

Healthy in a Hurry (Louisville)

Grand opening events for every store, organized cooking demos and used flyers and mailings

Technical Assistance

The Food Trust (Philadelphia)

Perishable inventory skills (ordering, handling, storage, and placement for best sales); nutrition education; business management skills (pricing)

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Generating Local Demand In interviews, respondents agree that one of the biggest challenges facing corner store conversion programs is the ability to support long-term profitability while selling fresh produce (Academic Expert, 2/20/2012; Expert, 2/23/2012; Expert, 2/6/2012). Without demand for fresh produce in corner stores, there is little hope that the stores will be able to continue stocking and selling fruits and vegetables (Academic Expert, 2/10/2012; CMC Program/Partner Staff, 1/25/2012). Corner store conversion programs can include a wide range of activities designed to increase demand in surrounding communities. These demand generation activities often focus on specific groups, like young people, in order to influence a community’s shopping, eating and cooking patterns. One common strategy is a marketing campaign, in which corner stores are branded as purveyors of healthy foods. This can be done through innovative advertising and creative signage. In New York City, for example, the Healthy Bodegas signage and stickers are recognized throughout the city and indicate to community members that healthy foods are sold in associated shops (Expert A, 3/20/2012). Community outreach and education are also common, with many programs providing cooking classes and community workshops to generate demand. Along with the cooking classes, some programs (such as The Food Trust in Philadelphia) hand out recipe cards that feature healthy ingredients found in the corner stores (Expert B, 3/7/2012). Community members can be leveraged to promote healthy eating, similar to the Promotores program that enlists community members to promote health in underserved and low income communities through mentorship and support resources (Expert, 2/17/2012). Outreach also commonly includes door-to-door informational campaigns and grand opening events with music, education, and other activities. Some argue, however, that small-scale demand generation activities, such as doorknocking campaigns and other community outreach events, tend not to have lasting impact (Expert, 2/23/2012; Store owner, 3/23/2012). One expert argues that market demand efforts need to include “large scale education campaigns about sodas and unhealthy foods” in order to have an impact (Expert, 2/23/2012). Programs are also competing with the marketing power of the processed food and soda industry, and many programs require store owners to remove advertising for alcohol, tobacco, sugar-sweetened beverages, and unhealthy foods. Bridging Supply and Demand: Physical Makeovers and Community Engagement Often, necessary physical infrastructure such as refrigeration equipment is lacking, so physical store changes are necessary. However, physical transformations can serve a broader purpose, bridging both the supply and demand approaches. Physical store

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improvements range from the minor reorganization of shelf space or redesign of floor plans, to major interior and exterior renovations. Because store characteristics send signals and cues to customers, it is often critical to change the overall atmosphere of a store to indicate to customers that what was once a place to buy alcohol and unhealthy snacks is now a source for high-quality, healthy produce (Expert, 2/3/2012). Interior changes are common, but the extent of the change varies considerably. As noted above, infrastructure improvements and installation of equipment for storage and display of produce are often required to maintain supplies of fresh food. Other changes, however, are designed to make healthy options more prominent in order to increase sales. Almost all of the programs included in the study rearranged their displays by shifting healthy items to the front of the store. Interior renovations may also include installation of new shelving, improved lighting, and removal of bars or glass barriers between customers and cashiers. These changes in store design and layout not only make produce more prominent but also make stores more inviting. Baldwin Park Corner Stores Baldwin Park, CA As part of its Healthy Eating Active Communities (HEAC) initiative, the California Endowment selected Baldwin Park as one of their target communities. HEAC examined the environmental impacts of childhood obesity, with one focus area being the issue of food access as it related to choices around schools. Beginning in spring 2007, a group of youth performed the Corner store Marketing Audit, detailing the corner store landscape around schools and documenting the presence of junk food in each store. While the store owners were hesitant at first, the youth convinced them that offering healthy foods was not only beneficial for business but also good for children’s health. Starting in eight stores, healthy items were tagged with the “Healthy Selection” sticker (designed by a student) and stores received significant promotion and marketing, including support from the city. Currently, a volunteer task force advisory committee composed of residents, city officials, and others manage the 16 participating stores by visiting the stores weekly and providing training. Recognizing that enforcement is a challenge, the program manager and the task force are working with the city to implement policy that would dictate healthy foods to be a certain percentage of a store’s layout. Through this dialogue, city officials recognize the correlation between access and community health. The corner store conversion program has been embraced as part of the city’s Healthy Baldwin Park vision, a comprehensive community-wide initiative that aims to make policy changes based on improving the health of their citizens.

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In terms of exterior changes, full-scale façade renovations are uncommon, but smaller changes are often made. For example, lighting outside of stores may be improved, as it was in Louisville (Expert A, 3/7/2012). Bars may be removed from windows, and some programs help with exterior signage. Often, as in the East LA Market Makeover program, stores are repainted in bright, welcoming colors (Academic Expert, 2/10/2012). As with interior renovations, these changes are designed to signal a change in the store and to make stores more inviting. In addition to physical improvements, another common design element that bridges supply and demand is community engagement. Community input can provide valuable feedback for store owners to ensure that they are supplying the types of products desired by customers, especially when there are ethnic food items that are unavailable in other retail outlets. Community engagement also ensures that outreach and educational materials are appropriate for the community and that stores are held accountable to their commitment. Community engagement may also provide a foundation for other demand generation activities. For example, several programs work with students in local schools to develop marketing and outreach materials, conduct assessments of stores, and carry out doorknocking campaigns and cooking classes. Local volunteer organizations are also in a position to mobilize local support. The form in which community engagement takes place, however, has the potential to greatly influence a program’s outcomes, and this is discussed in greater detail below. Implementation Matters: Supporting Success and Sustainability Regardless of how well a program is designed, the success and sustainability of a program is determined by its implementation. This study found that there are a number of factors that influence program implementation and, therefore, both the execution of program design in the short term and program success, sustainability, and scalability in the long term. The most important factors are: • • • • • •

A community-driven process with meaningful community engagement Development of strategic partnerships Stable and long-term funding Strategic store selection process An incremental or tiered approach Leveraging existing policy and program structures

Each of these factors is discussed in detail below.

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Community-Generated and Community-Driven Process Community engagement is generally agreed to be essential for program success, but it is critical that community engagement be meaningful and intentional. In fact, the most important concern for implementation is that meaningful engagement occur from the outset so that the creation of a corner store conversion program is driven by local stakeholders: business owners; community organizations; or local residents (Academic Expert, 2/10/2012; Academic Expert, 2/15/2012). Such a “ground up” approach helps to ensure that the program is more responsive to existing demand and community-identified needs, which in turn increases the likelihood of program sustainability and develops a sense of community ownership in the program.

!"#$%&'(&$)%$'%$*#+),-#./$),($ There are a number of compelling examples of community-driven 0%112#-)+$123)$4($(#.*.('$)%$.()$*$ processes. In the case of Detroit FRESH, 3(#3($%5$6,*)$),(+$6*#)$*#'$6,-0,$ citizens gathered together to address the lack of healthy foods in their 3)&*)(.-(3$6%27'$4($1%3)$5(*3-47(8$")$ neighborhoods and identified corner store -3$*#$%#.%-#.$'-*7%.2($*4%2)$6,*)$ conversions as a potential solution 0*#$4($'%#(/$*$'-*7%.2($-#$6,-0,$),($ (Expert, 3/8/2012). Similarly, in San Francisco, the Good Neighbor Program 0%112#-)+$123)$9*&)-0-9*)(8:$ (which was the predecessor of the ;?@A?@> Southeast Food Alliance) began as a community-based participatory research project in which youth in the BayviewHunters Point neighborhood carried out assessments of retailers in their community, and then identified the lack of retail space devoted to healthy fresh foods as the most important issue to address (Expert, 3/21/2012; Expert, 4/5/2012). The programs included in this study leveraged community engagement in varying degrees and in a variety of forms. In some cases, citizens are part of the planning process, with “community input being incorporated in all levels of involvement and driving the process” – for example, forming steering committees that are representative of the greater community to define a project’s vision and guide its development (CMC Program/Partner Staff, 2/8/2012). This is occurring in Baldwin Park, where the resident council is in charge of keeping the stores accountable in carrying healthy foods (Expert, 3/12/2012). Community engagement may also help to ensure the sustainability of programs by keeping community members interested in the program, holding store owners accountable, and ensuring that the program continues to meet community needs. In New York City, for example, the companion to Healthy Bodegas is Adopt a Bodega, in which community

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Southeast Food Alliance (SEFA) San Francisco, CA SEFA grew out of the Good Neighbors program in San Francisco. The Good Neighbor Program engaged youth in the Bayview Hunter’s Point neighborhood in community-based participatory research to assess the retail environment. These activists identified a striking lack of healthy food as the most important issue, and they began working with local store owners to increase healthy food options. The Good Neighbor program was discontinued, but in 2007, a group of Bayview Hunter’s Point residents gathered together to discuss food issues, galvanized by the fact that there was the lack of a large grocery store. From that point, the Southeast Food Alliance (SEFA) was created to build on the work of the Good Neighbor program. Now young adults, some of the youth advocates work as SEFA’s Food Guardians and spearhead community outreach, store assessment, and more. SEFA is a partnership between public agencies, community-based organizations, and others. Two of its members are employees of the San Francisco Department of Public Health who have SEFA written into their work description. In addition, the two volunteer co-chairs have important community ties, especially since one of them is the general manger of the San Francisco wholesale produce market, which is located in the neighborhood. Sutti and Associates, a national food retail consulting firm, has offered to provide pro bono technical assistance, layout design, and planning for physical makeovers. Uniquely, the level of store participation is dependent on the owner’s interest, and SEFA has created tiered levels of involvement. SEFA is an excellent example of a number of community partners coming together to address a very pertinent issue.

groups adopt stores and work with store owners to maintain the sustainability of the program (Expert A, 3/20/2012). Both parties benefit from this new partnership, with stores being supported as people’s eating behaviors become healthier, while residents continue working to better their food environment. A number of existing programs have successfully harnessed the energy of youth advocates to drive corner store improvement projects. As discussed above, the Southeast Food Alliance (originally the Good Neighbor Program) in San Francisco began as a youth engagement project, and today its community-level healthy retail program is driven and carried out by young professionals called Food Guardians. These Food Guardians conduct extensive annual assessments of all food retailers in the community, return to offer store owners feedback, and work with interested store owners to increase their offerings of

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healthy foods (Expert, 3/21/2012). Also in the Bay Area, Mandela MarketPlace in West Oakland has successfully harnessed the passion of local young people who staff their cooperative market and have developed a produce delivery service to increase the availability of fresh produce in local stores (Expert B, 3/20/2012). Others recognize the importance of community engagement but note that “their input needs to be leveraged and used efficiently” (Expert, 2/17/2012). Along with community engagement, one expert highlighted the notion of having a “common goal based on commonality around values and principles” (CMC Program/Partner Staff, 2/17/2012). Without agreeing to a common goal and vision, the power of community involvement can be difficult to harness and utilize. When community members view their involvement as token or unimportant, however, the benefits of community engagement are negated, and this can have significant implications for long-term success. Strategic Partnerships As discussed above, programs designed to address both supply and demand involve a wide variety of activities, from community outreach to technical assistance to physical renovations. Very few organizations are equipped to provide all of these services efficiently or effectively on their own. As a result, strategic partnerships are key to successful implementation. In order to best leverage the resources and service capacities existing in the community, a successful program is often a partnership between the community, local government, existing community non-profits and/or foundations or universities. !

Community stakeholders can serve as important advocates for the program. In particular, local shop owners can foster entrepreneurship amongst other food vendors in the community.

!

Local government agents can provide business guidance and support and help store owners navigate the permitting process and take advantage of funding opportunities and other incentives. Also important are local public health departments. For example, Louisville’s Health in a Hurry emerged when public health departments employed obesity-prevention funding from the Centers for Disease Control to resolve food access issues (Expert A, 3/7/2012). Local government support may also provide stability and legitimacy.

!

Foundations and universities can provide longer term funding and participate in evaluation activities. East LA’s corner store conversion program is handled by UCLA, for example, with funding provided by the National Institutes of Health (Academic Expert, 2/10/2012).

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Table 2: Corner Store Elements

Unique Corner Store Conversion Elements Community-driven process and engagement

Health in a Hurry

Focused on the neighborhood pocket around each store, incorporating neighborhood associations and other organizations

Mandela Marketplace

From the beginning, the community identified foodrelated needs and assisted in the creation; youth deliver produce to the stores

UCLA East LA Program

Detroit Fresh Strategic Partnerships Southeast Food Alliance

DC Healthy Corners

Tiered approach and incentives

Developed in collaboration with Community Advisory Board; youth engagement Housed at Wayne St. University which provides evaluation metrics support; in partnership with Capital Soup Kitchen Partner with San Francisco Department of Public Health, Sutti and Associates (grocery consultants), and San Francisco wholesale produce market DC Central Kitchen is the lead organization, partnered with DC Department of Public Health and other key community partners; funding provided by DC’s Dept. of Small Business Development

The Food Trust

Four levels of changes, with the store owners moving to the next one after satisfying the previous requirements

Detroit FRESH

Store that do more will get more, tailored involvement and assistance

Healthy Bodegas

Minneapolis Corner Store Leveraging existing or new policies

DC Healthy Corners

Baldwin Park Healthy Corner Stores

Incentivized change, once stores met a criteria, received items to aid the owner in helping to promote healthy produce; different incentives dependent on the changes made Staples Foods Ordinance mandates all stores with a grocery license to carry a number of fruits, vegetables, meats/protein, dairy and bread/cereal and the Corner Store program is helping owners meet these requirements DC City Council passed the FEED Act and commissioned the Healthy Food Retail Program, which required the District to look at corner stores and small retailers as part of its strategy to increase healthy foods and find a local nonprofit that would provide assistance to these very stores City is currently looking at passing an ordinance that would mandate healthy foods to be a certain percentage of a store’s layout

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Non-profits are well suited for program administration as they can connect local government agencies to store owners and community members. Throughout the country, public health departments have teamed up with respected community organizations to administer the corner store conversion programs. For example, the Food Trust provides the Philadelphia Health Department established networks to help disseminate the program across the city. Together, they have reached over 600 corner stores across Philadelphia (Expert B, 3/7/2012).

Longer-term and More Secure Funding Perhaps the most difficult requisite of implementation is sustained long-term funding. Grants are often time-restricted, meaning that marketing, outreach, TA, and other important supports can only be sustained for a limited time. As a result, many changes brought about by short-term interventions have been found, after several years, to be abandoned by store owners (Expert, 2/23/2012). Sustained success requires support and oversight of participating stores, and this is difficult when funding is limited to the short term. Recognizing that many funding sources are short-term or dependent upon ongoing budgetary support, it is important for programs to plan for funding changes, as much as possible. Social enterprise development is an interesting solution to issues with external funding, but most market makeover programs do not lend themselves to social enterprise because there is no associated revenue source. In Oakland, however, Mandela MarketPlace is evaluating the potential for its produce supply service to become a social enterprise (Expert B, 3/20/2012). This would free the organization from funding restrictions while enabling staff to work on programming rather than fundraising and grant application and management. Strategic Store Selection Store selection is an important aspect of successful implementation, in two senses. First, store owners must be motivated, enthusiastic, and committed to providing a service to their community. Second, stores should be selected where the intervention will have the greatest impact on the availability of healthy food.

“The most challenging stores are in the communities that need the most help. The stores that struggle the most are serving the most in need.” -Expert 3/07/12

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For many programs, a key consideration is whether or not to require stores be owner operated. This is particularly important when physical renovations are to be carried out, especially when the store owner is expected to take on financial responsibility, for example in the form of loans. Likewise, programs that require long-term commitments to stocking healthy foods may desire the greater stability of an owner-operated store versus a retail tenant. While this requirement helps ensure stability and simplifies administration it also narrows the pool of candidates and may make it more difficult to target stores with the greatest potential to change the existing food environment. Store selection has a profound affect on the degree to which a program can ultimately improve the food environment. Selecting a store near a large grocery store, for example, does not necessarily direct resources to an area in need of more healthy food options Additionally, such a store may also be less likely to succeed in sustainably stocking produce because large retailers can offer produce at lower prices. Similarly, selecting stores that already have refrigeration or already stock some produce, while making implementation easier and potentially lowering costs, may not provide the greatest opportunity to improve the food environment. An Incremental or Tiered Approach An incremental approach allows store owners to participate at levels appropriate for them, thus creating more buy-in and accountability from the participating stores – which is essential for scalability and for long term success of a program. Such a tiered approach both provides flexibility in program implementation and allows programming to be tailored to best meet the needs of individual stores. Additionally, this approach incentivizes store owners to continue making improvements in order to receive additional assistance. The Food Trust, for example, set up their program in four phases, where the store owners would only get to the next phase if they accomplished the requirements from the previous stage (Expert B, 3/7/2012). There are several levels of involvement short of a full-scale internal and external remodel that a new corner store program could support. One expert suggested a three-tiered model where the top tier is full physical renovation supported by technical assistance and demand generation services. The second level would be smaller scale internal renovations like new refrigerated display cases, a modified floor plan to emphasize healthy foods, and technical assistance and demand generation. Then the third tier would be produce baskets, assistance creating produce displays, and possibly participating in a joint purchasing program (if one existed) (CMC Program/Partner Staff, 1/25/2012).

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Leveraging existing policy and program structures Many of the programs included in this study took advantage of favorable existing policies and structures when developing their corner store programs. For example, as part of the store selection criteria, several programs included WIC/SNAP compliance because these stores were already required to carry a number of healthy items. Program managers believed they could capitalize on these requirements and encourage the stores to do even more. In Minneapolis, program developers took advantage of not only federal mandates, but also its own Staple Food Ordinance, which required all food-related stores to have specific healthy items (Expert, 3/1/2012). Public health officials seized the opportunity to build upon the Staple Food Ordinance and introduce healthy foods into corner stores throughout the city. Some cities saw healthy corner stores as means of economic development, using support from their small business development departments. New York City is unique in that it has the Center for Economic Opportunity, whose main focus is to improve the lives of the poor, and Healthy Bodegas was viewed as the program to do just that (Expert A, 3/20/2012).

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CMC PROGRAM: A SOUTH LA CASE STUDY

At its conception, the CMC program was envisioned to be a two-year process pilot where the community outreach and education component began in the first year and in the second year coincided with the beginning of the façade reconstruction and introduction of technical assistance. Everything was to conclude with the corner stores’ grand reopening (CMC Program/Partner Staff, 1/25/2012; CMC Program/Partner Staff, 2/23/2012). However, contracting issues between the various partners essentially cut the time allocated for demand generating activities in half. Furthermore, the instability of the CRA’s future and ultimate abolishment diverted the focus away from supporting the four CMC stores. As of now, it is uncertain whether the four stores will ultimately receive the planned physical renovations.

Figure 5: CMC Program Timeline

2010 CMC program is created

October 2011: Door knocking campaign with 40 volunteers

November 2011: Fall Harvest Launch events

April 2011: Contracts for CMC program managers are approved and CMC Pilot program begins

August 2011: Youth workshops and cooking demonstrations

January 2012: CRA is abolsished

June 2011: 4 stores are identified

July 2011: Community Health And Marketing Team is convened

March 2012: CMC Pilot program ends, store renovations have not occurred

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Community Market Conversion Program: Overview The Community Market Conversion (CMC) Program was a corner store conversion program offering physical renovations, technical business and marketing assistance and community public health outreach to four stores in CRA project areas in South Los Angeles. The program was housed in the Los Angeles CRA and was funded by the CRA, the Department of Public Health’s Project RENEW, and the California Endowment (See Figure 4). The physical renovations were an extension of the CRA’s longstanding commercial façade rehabilitation loan program. The supplemental community outreach and technical assistance components of the CMC Program were a one-year pilot that ended in March 2012. For a detailed description of the CMC Program see Appendix B. Figure 3: Locations of stores participating in CMC Program

Goals and Objectives The CMC Program’s goal was to shift consumption patterns in the community, resulting in positive public health outcomes, by simultaneously providing increased access to fresh produce and community outreach to generate demand for the new healthy offerings in participating stores, Additionally, providing technical and marketing assistance to the store owners was intended to help make their new business model profitable in the long term and increase the likelihood that they would continue to stock fresh produce. Full façade rehabs were designed to create more appealing stores and spur additional economic development in the community. Program Mechanics The CMC Program consisted of three main elements: 1. CMC Conditional Loan Program: The CRA would provide loans of up to $95,000 for architectural designs, exterior façade rehabilitation, interior construction, floor plan redesign, new refrigeration and other infrastructure necessary for the sale of fresh produce. Loans would be forgiven after ten years if store owners maintained sales of produce and did not increase liquor sales. This loan included technical assistance to help the business owners transition to selling fresh produce and other healthy foods. 2. Community engagement: A steering committee of community stakeholders participated in store selection, and a Community Health and Marketing team was convened to plan and execute activities to promote the program and the stores. 3. Marketing and Demand Generation: The program planned to market the stores post-conversion, and do significant public outreach in the community to generate demand for the new produce in the stores. They planned to work with community youth as well, and held several workshops with youth over the summer of 2011. Future of the CMC Program As of the writing of this report, the physical renovations for the four stores participating in the pilot program have not yet begun, though they are considered among CRA/LA’s enforceable obligations. It is uncertain whether the renovations will proceed, and if they do, whether the stores will still be obligated to sell produce in order to have the loan forgiven. As per the terms of the RENEW grant, the demand generation activities, community outreach, and public health education efforts have ceased, with the CMC Pilot Program ending in March 2012.

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Community Market Conversion Program: Funding Streams CRA/LA provided the bulk of the funding for the CMC program, as the physical renovations were the greatest expenditures of the program by far. LANI was contracted to provide the majority of project management, but existing CRA project management staff were assigned specifically to manage the physical renovations (CMC Program/Partner Staff, 1/25/2012; CMC Program/Partner Staff, 2/8/2012). CRA funds did not support any staff or other resources that were related to any of the community outreach efforts; they were exclusively allocated for the physical transformations (CMC Program/Partner Staff, 1/25/2012). Project RENEW was funded through the Center for Disease Control’s Communities Putting Prevention to Work (CPPW) Initiative, and is a two-year project which concluded in March 2012. As a subgrant, the CMC timeline was tied to that of Project RENEW’s CPPW grant. Project RENEW funds supported the activities of the CMC Program that advance the public health and community involvement goals shared by the two programs (CMC Program/Partner Staff, 1/25/2012; CMC Program/Partner Staff, 11/17/2011). The California Endowment provided additional funding to supplement the Project RENEW funding for community outreach, education and demand generation components of the CMC Program. One of the priorities of the California Endowment grant was to involve community youth in the program and implement an educational component about healthy eating. As with the RENEW funding, none of this money went towards the physical transformation of the stores (CMC Program/Partner Staff, 1/25/2012).

Figure 4:

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Formative Evaluation Using the logic model as a framework for evaluation of the CMC Program, the research team examined whether the programmatic elements of the CMC Program were structured in a way that was conducive to producing the program’s intended outcomes and, ultimately, achieving its long-term goals (see Appendix A). Additionally, this study analyzed the implementation of the program and how both program design and unanticipated factors influenced implementation. The study also investigated whether the institutional design of the program facilitated a sustainable, scalable, and successful corner store conversion model. The CMC Program incorporated a number of design elements that contribute to the strength of a program, as discussed in the preceding section. The program utilized strategic partnerships, emphasized community engagement, incorporated demand-generating activities, and planned to perform extensive physical renovations. However, it also ran into a number of implementation problems that limited its ability to fully realize its potential. Bureaucratic inefficiencies with both the Department of Public Health (DPH) and the CRA/LA shortened the operating time of the pilot program and made the process of implementing program activities slow and cumbersome. The goal of actively engaging the community was never truly achieved, and the demand generation activities were superficial, were not sustained, and did not coincide with the physical renovations of the stores. Additionally, the store selection criteria and process resulted in the selection of four stores that were not best positioned to succeed in the long term. The biggest implementation challenge, which no one could have predicted at the outset, was that the California redevelopment funding – and therefore all community redevelopment agencies – was abolished in January 2012. Implementation Matters: What can go wrong? As discussed above, the best-designed program’s success or failure is determined in its implementation. The CMC Program provides an opportunity to understand how implementation issues may undermine a theoretically optimal program. Institutional Design Issues: Inflexible Bureaucracies In research and interviews, the importance of creating strategic partnerships and leveraging a wide variety of expertise was repeatedly emphasized. On paper, the CMC Program did exactly that, partnering with CRA/LA, DPH, the Los Angeles Neighborhood Initiative (LANI), and the California Endowment. However, in practice, coordinating between so many agencies proved difficult, and made coordinating activities a challenge. While CRA is unique in its capacity to fund full-scale reconstruction projects, every other component of the CMC program was funded by the Project RENEW grant at DPH (with a matching grant from the California Endowment) and was therefore contingent on securing the contracts between the

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CRA and DPH. The RENEW grant was for two years, and when contracting procedures between the CRA and the County of Los Angeles delayed the program by nine months, the timeline for the community outreach and demand generation activities was essentially halved (CMC Program/Partner Staff, 2/23/2012). The CMC pilot was designed to be a twoyear program; however, due to the lengthy contracting process through the County of Los Angeles, which delayed the start of employment for CMC program staff, it effectively became a one-year pilot program. The CMC program’s limited timeline, as designed, would not work given its dependence on two inflexible government administrative institutions. CRA’s Disbandment: A Lingering Cloud of Uncertainty Beginning in Summer 2011, the potential abolishment of the CRA cast a cloud of uncertainty over the entire CMC Program. The ongoing court battle over redevelopment funding that resulted in the disbandment of Community Redevelopment Agencies across the State of California in January 2012 first disrupted the timing of the CMC Program activities, making the community outreach and demand generation activities uncoordinated with the physical renovations of the stores. Originally, renovations were intended to take place over the fall of 2011, and the CMC program would have been able to implement comprehensive community engagement and marketing activities in the winter and spring of 2012 before the program concluded as scheduled in March 2012. However, in practice, the CMC Program coordinators had to scramble to introduce some produce (the Fall Harvest Soft Launch), while awaiting the outcome of the CRA lawsuit. While the legal battle with the CRA could not have been predicted, and is not in itself a design flaw of the CMC Program, it does emphasize the importance of secure funding sources and coordinated supply and demand activities. Currently, it remains uncertain whether or not the renovations of the four CMC stores will proceed. The three-person governing board serving as the successor agency overseeing the CRA’s dissolution approved the contracts for the technical assistance consultant and for LANI, however they will not be paid. Additionally, while the renovations are on a list of enforceable obligations, they have not yet been approved, and a second, higher-level county agency needs to approve them. Furthermore, as originally designed, the participating CMC stores were to receive a conditional loan from the CRA, which would be contingent on the stores maintaining the provision and sale of fresh produce over ten years.

“To move this work forward, the Food Policy Council needs to work with the community, but really meet them where they’re at...” -Expert, 4/26/2012

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CRA project managers were to oversee this, but it is not likely that the successor agency will provide the staff capacity necessary to see that the stores remain accountable. If the renovations do proceed, it seems likely that the investment will be more like a gift to the stores than a loan (CMC Program/Partner Staff, 4/20/2012). Lack of Meaningful Community Engagement Successful programs are ones in which community engagement is leveraged strategically, and where the demand for a conversion program is generated within the community and initiated amongst the store owners. Community and youth engagement were incorporated throughout the CMC program’s design, but not utilized as envisioned. The idea for the CMC program was based on California Endowment’s Healthy Eating, Active Communities (HEAC) program, which used a youth-driven advocacy model for converting corner markets, and partnering with the California Endowment was to ensure a continuation of this model (CMC Program/Partner Staff, 2/23/2012). However, in the end, the California Endowment’s role materialized through supplementing the funding of the two CMC program coordinator positions rather than in the form of meaningful youth engagement. In addition, the criteria for store selection criteria included proximity to schools

CMC Store Profile: Money Saver Meats Money Saver Meats, on the corner of Florence and Crenshaw in South LA has bars on its small street-facing windows and outer signage advertising homemade sausage and the acceptance of EBT. For over 20 years the store has been known for its house-made chicken and turkey sausages that are low-fat and low-sodium. The customers tend to be predominantly African American and living in the surrounding neighborhood. As a longtime vegetarian, enthusiastic juicer and vegan recipe connoisseur, store owner Ozabe Banks strives to personify a healthy lifestyle. He envisions that his store will ultimately become a health food store and is driven by his belief in the importance of eating healthy and his desire to be a leader on this front in his community. Although he has attempted to sell fresh produce over the years, existing customers never embraced the effort, and new customers never materialized. Mr. Banks is extremely positive about the pending renovations from the CMC program, and has participated in all of the activities the program has put on including the “door-knocking” campaign in the fall and the “Fall Harvest” launch event. However, the challenges to selling produce lay evident throughout the store. A large table devoted to fresh produce contained one small basket with garlic and another with one onion. Several refrigerated cases under a sign saying “Fresh Produce!” lie empty. These displays were set up by the CMC program after the “Fall Harvest” event and resulted in some customers returning to the store to buy produce. However, no new customers emerged, and produce sales tapered off within weeks. With the nearest supermarket over 4 miles away and the high cost of gas, Banks is sure that the issue is the lack of advertising and marketing notifying customers about the healthy produce offerings.