In this chapter, we draw on research conducted in Detroit, Michigan, between 1996 and 2008 as a case study of one approach for understanding how the neighborhood retail food environment
Trang 1Notes 41
31 Morello - Frosch, R A Discrimination and the political economy of
environmen-tal inequality Environment and Planning C: Government and Policy, 20 (2002):
477 – 496
32 Whiteside, K Precautionary Politics: Principle and Practice in Confronting
Environmental Risk Cambridge, Mass.: MIT Press, 2006
33 Morello - Frosch, R., Pastor, M., Jr., and Sadd, J Integrating environmental justice
and the precautionary principle in research and policy making: The case of ambi-ent air toxics exposures and health risks among schoolchildren in Los Angeles
Annals of the American Academy of Political and Social Science, 584 (2002):
47 – 68
34 California Environmental Protection Agency Air Resources Board Integrating
indicators of cumulative impact and socioeconomic vulnerability into regulatory decision - making Dr Manuel Pastor, University of California, Santa Cruz
Available at www.arb.ca.gov/research/apr/archive/oct04/oct04 – 1.htm Accessed June 26, 2008
35 Pellow, D N Garbage Wars: The Struggle for Environmental Justice in Chicago
Cambridge, Mass.: MIT Press, 2002
36 Bautista, E Taking Out the Garbage New York: n.d
37 OWN/Consumers Union Taking Out the Trash New York: n.d
38 The City of New York PlaNYC2030 Available at www.nyc.gov/html/planyc2030
Published April 22, 2007 Accessed June 26, 2008
39 Freire, P Pedagogy of the Oppressed New York: Continuum, 2002
40 Tai, S Environmental hazards and the Richmond Laotian American community:
A case study in environmental justice Asian Law Journal, 6, no 1 (1999):
189 – 207
41 Asian Pacifi c Environmental Network (APEN) Available at www.apen4ej.org
Accessed June 26, 2008
42 Asian Pacifi c Environmental Network, Communities for a Better Environment,
Environmental Health Coalition, People Organizing to Demand Environmental &
Economic Rights, Silicon Valley Toxics Coalition/Health and Environmental
Jus-tice Project Building healthy communities from the ground up: Environmental justice in California Available at www.rachel.org/fi les/document/Building_
Healthy_Communities_from_the_Ground_Up.pdf Accessed February 2, 2009
43 University of California at Berkeley Health Impact Group (UCBHIG) Health
impact assessment projects: Oak to Ninth Avenue health impact assessment
Available at http://ehs.sph.berkeley.edu/hia/O2N.HIA.ExecSum.pdf (Executive Summary) Accessed February 2, 2009
Trang 3PA RT
2
INTERDISCIPLINARY APPROACHES TO STUDYING CAUSES
OF URBAN HEALTH
PROBLEMS
Trang 5C H A P T E R
3
INTERDISCIPLINARY, PARTICIPATORY RESEARCH ON URBAN FOOD ENVIRONMENTS AND DIETARY BEHAVIORS
SHANNON N ZENK, AMY J SCHULZ, ANGELA M ODOMS - YOUNG, MURLISA LOCKETT
LEARNING OBJECTIVES
■ Describe how differences in neighborhood food environments can contribute to
differences in the health of populations in different neighborhoods
■ Analyze the different ways that individual - level and neighborhood - level factors
infl uence diet, nutrition, and obesity
■ Present a rationale for using community - based participatory research methods to
study neighborhood food environments
Trang 646 Interdisciplinary Research on Urban Food Environments
■ Discuss the challenges that interdisciplinary researchers working with
communities face and some of the strategies they can use to overcome these challenges
INTRODUCTION
Poor diet is a major risk factor for several diseases, including diabetes, cardiovascular
disease, and certain cancers, from which African Americans experience excess
mor-bidity and mortality when compared with whites Until recently, research had mainly
focused on the role of individual and familial factors in dietary practices and
dispari-ties However, over the past few years, an explosion of research has documented
inequalities in the accessibility of retail food outlets (e.g., supermarkets, fast - food
restaurants) and in the food supply (e.g., food availability, selection, quality, price)
across neighborhoods, with low - income and racial/ethnic minority neighborhoods
often having fewer nutritional resources (e.g., supermarkets) and more nutritional
hazards (e.g., low - quality fresh produce) 1 – 10 There is growing interest in
understand-ing whether and how neighborhood “ food environments ” affect dietary behaviors and
contribute to racial/ethnic disparities in diet and related health outcomes From the
early work of Cheadle and colleagues to more contemporary studies, 11 – 18 accumulating
evidence suggests that people who have food options closer to home that support
heal-thy eating have better dietary quality or healthier body weights Given that 81 percent
of African Americans live in urbanized areas (densely populated areas with at least
50,000 residents) and 60 percent live in urban centers (generally incorporated places
or census - designated places with the most population within urbanized areas), 19
under-standing whether and how neighborhood food environments affect residents ’ dietary
intake and health is especially important in urban settings to eliminate black - white
disparities in health
In this chapter, we draw on research conducted in Detroit, Michigan, between 1996 and 2008 as a case study of one approach for understanding how the neighborhood
retail food environment affects dietary behaviors and the health of urban populations
This research engaged academic researchers and representatives of health service and
community - based organizations It employed theoretical perspectives and research
methodologies (i.e., spatial mapping, community surveys, in - person observations) of
several academic disciplines: health behavior and health education, sociology,
commu-nity nutrition, nursing, epidemiology, and geography We fi rst consider distinctive
determinants of contemporary retail food environments in cities, highlighting
circum-stances in Detroit We then describe efforts of, and lessons learned by, community - based
participatory research (CBPR) partnerships working to understand the health
implica-tions of retail food environments in Detroit We conclude by discussing next steps for
research that examines the contributions of retail food environments to dietary behaviors
and the health of urban populations
Trang 7Determinants of Retail Food Environments in Cities 47
DETERMINANTS OF RETAIL FOOD ENVIRONMENTS IN CITIES
Detroit, like many other cities, has experienced dramatic shifts in the retail food
land-scape over the past few decades The spatial distribution of grocery stores is one aspect
of the retail food environment that has changed Factors contributing to grocery store
closures and rare store openings within cities are multifaceted 20 – 25 However, many of
the factors that have shaped the contemporary retail food environment in Detroit and
other midwestern and northeastern cities in the United States stem from at least three
interrelated historical forces: racial residential segregation, economic restructuring,
and restructuring in the retail food industry
Racial Residential Segregation
A major factor shaping the retail food environment in metropolitan Detroit since 1950
has been racial residential segregation Following World War II, fears of racial
integra-tion prompted white residents to fl ee the city for the suburbs, as increasing numbers of
African Americans moved into previously all - white neighborhoods Between 1950
and 2000, Detroit lost over half of its population and transitioned from 16 percent to
81 percent African American 19 , 26 In contrast, by 2000, more than 80 percent of
resi-dents in metropolitan Detroit were non - Hispanic white 19 Metropolitan Detroit is
currently one of the most racially segregated urban areas in the United States 27
The closing of white - owned grocery stores and opening of Middle Eastern – owned food stores were two outcomes of white fl ight in Detroit 28 According to informal
esti-mates from trade associations, people of Middle Eastern descent now own 80 to 90
percent of Detroit ’ s grocery and liquor stores 28 Some African American residents view
the fact that most food store owners and employees are of a different racial/ethnic
background as a symbol of economic inequalities in Detroit 29 , 30 More over, many
Detroit residents report being discriminated against — watched, followed, treated with
disrespect — when frequenting local food stores 28 , 31 Strained race relations between
many residents and store owners and employees may negatively infl uence residents ’
perceptions of foods available to them, their food shopping behaviors, and their mental
well - being 32 – 34
Economic Restructuring
The contemporary retail food environment in Detroit has also been profoundly shaped
by economic restructuring Fueled by the rise in the automotive industry, Detroit was
growing and prosperous in the early to mid - twentieth century 30 , 35 , 36 However, economic
restructuring after World War II, particularly relocation of industries from the city to
the suburbs and deindustrialization, led to the loss of over 250,000 manufacturing jobs
between 1947 and 1992 36 Further job loss and economic divestment followed the loss
of manufacturing jobs Between 1960 and 1990, the city of Detroit lost about 350,000
jobs, whereas the surrounding metropolitan area gained more than twice that number 36
Stemming in part from the disappearance of good - paying, blue - collar employment
Trang 848 Interdisciplinary Research on Urban Food Environments
opportunities, the percentage of residents living below the federal poverty line in
Detroit was over four times greater than in the rest of metropolitan Detroit in 2000
(26 percent vs 6 percent) 24 , 37 , 38 Although research documents untapped purchasing
power in urban neighborhoods, including Detroit, 21 , 24 , 38 food retailers cite lack of
profi tability as a reason they pulled out and continue to avoid investing in Detroit and
other cities
Restructuring in the Retail Food Industry
A third historical factor shaping Detroit ’ s current retail food environment is
restructur-ing of the retail food industry Consolidation in the retail food industry beginnrestructur-ing in
the 1950s is one aspect of restructuring, including movement from independently
owned stores to corporately owned chains, as well as mergers and leveraged buyouts
that created even larger corporations 21 , 22 By the 1970s, many independent grocery
stores could not compete with the prices offered at chain stores, which could exploit
economies of scale; thus, many independent grocers were forced to close 22
Unfor-tunately, as Detroit ’ s white population shifted from the city to the suburbs after World
War II, grocery stores began closing in the city, and many chains avoided locating new
stores in Detroit due in part to racial stereotypes and associated fears of crime in an
increasingly African American city 21 – 23 Instead, grocery chains took advantage of
abundant and inexpensive land in the suburbs, which allowed them to build large store
formats at a lower cost Scarcity of land to accommodate large store formats (e.g.,
supercenters, superstores), high prices to develop sites, or both also contributed to the
loss of supermarkets from cities 24 Supermarkets ’ abandonment of the city, with
accom-panying loss of jobs and tax revenues, exacerbated already deteriorating economic
conditions in Detroit
In sum, racial residential segregation, economic restructuring, and restructuring in the retail food industry have had negative repercussions for the current retail food
land-scape in Detroit As one Detroit resident, participating in a focus group on facilitators
and barriers to healthy eating and physical activity, observed: “ You ’ ve got to go out
into the suburbs now to get some decent food And therefore, it ’ s not available to us in
this community By the time you get to that store and get some fresh fruits and
vegeta-bles, you ’ re going to pass about 30 fast food joints and about 100 liquor stores ” 31
USING CBPR TO UNDERSTAND THE HEALTH IMPLICATIONS
OF DETROIT ’ S FOOD ENVIRONMENT
As highlighted by the preceding quotation, Detroit residents do not view the local
retail food environment as supportive of healthy eating In this section, we describe how
the retail food environment in Detroit became a focus of the work of two community
based participatory research (CBPR) partnerships: the East Side Village Health Worker
Partnership (ESVHWP) and the Healthy Environments Partnership (HEP) We also
describe how expansion of the research teams to include scholars with a wider range
Trang 9Using CBPR to Understand the Health Implications 49
of disciplinary perspectives facilitated work of these partnerships between 1996 and
2008 as we began and have proceeded with work aimed at understanding the role of
the retail food environment in health variations among Detroit residents We will then
discuss lessons learned in using an interdisciplinary, participatory approach to study
the urban retail food environment
Concern about the retail food environment emerged initially in the context of the ESVHWP Initiated in 1996, the goal of the ESVHWP was to identify and address,
using a lay health advisor approach, social determinants of women ’ s health in eastside
Detroit 39 Lay health advisors (known as “ village health workers ” ) and community
rep-resentatives (including coauthor Murlisa Lockett) involved in the ESVHWP identifi ed
diabetes as a priority in 1999 Facilitated by disciplinary training in health behavior,
health education, and sociology of the initial academic researchers (including coauthor
Amy J Schultz), as well as by the engagement of a postdoctoral fellow with a
commu-nity nutrition background (coauthor Angela M Odoms-Young) and other individuals
and community organizations with expertise in diabetes, the ESVHWP in 2000 – 2001
developed a pilot project to prevent diabetes, Healthy Eating and Exercising to Reduce
Diabetes (HEED) 40 In conversations among those involved in HEED, residents in
east-side Detroit described the scarcity of fresh fruits and vegetables at local stores and
diffi culties securing rides from family and friends to reach suburban supermarkets to
obtain fresh produce They also described how the dearth of supermarkets and high
quality, reasonably priced nutritious foods made it diffi cult for residents to maintain a
healthful diet In response, the ESVHWP initiated healthy soul food cooking
demon-strations to provide skills in healthy food preparation and monthly fruit and vegetable
“ minimarkets, ” which were later expanded to bimonthly due to high demand 40 Designed
to increase the availability of a wide variety of high - quality fresh produce at low prices
in eastside Detroit, the minimarkets sold a variety of produce items at wholesale prices
at readily accessible community sites, including community centers and churches In
addition, as described below, members of the ESVHWP began new data collection
efforts to understand the retail food environment, which required knowledge and
research methodologies from other disciplines (e.g., geography, urban planning)
Documenting Locations of Food Resources
A public health doctoral student working with the ESVHWP (Shannon N Zenk) had
general interests in nutrition and the role of neighborhood environments in health
disparities She initiated new data collection to systematically document the
distribu-tion of food resources across Detroit area neighborhoods Training was offered through
other disciplines (e.g., a semester - long geographic information system [GIS] course
offered through the University ’ s Department of Natural Resources), and it was
dis-tinctly interdisciplinary (e.g., a fi ve - day workshop on accessibility measurement
sponsored by the Center for Spatially Integrated Social Science [CSISS]) There were
also interactions with geographers at the university ’ s map library and statistical
con-sulting center and an economist with expertise in spatial statistics All provided
Trang 1050 Interdisciplinary Research on Urban Food Environments
opportunities to learn new research methodologies for data collection (e.g., GIS) and
data analysis (e.g., spatial econometrics)
To examine the spatial accessibility of supermarkets, we used GIS to map the locations of supermarkets in metropolitan Detroit We found that the city of Detroit
had only nine supermarkets for 950,000 residents in late 2002, whereas supermarkets
were abundant in the surrounding metropolitan area The results also showed
inequi-ties in the distance to the nearest supermarket by neighborhood racial composition and
poverty level, with the longest distances to supermarkets found for the most
economi-cally disadvantaged neighborhoods where African Americans lived 41 At the same
time, we also conducted in - person audits of food stores in four Detroit area
communi-ties to explore whether a good selection of affordable, high - quality fresh fruits and
vegetables was less available in an economically disadvantaged African American
community than in more advantaged communities This project entailed developing an
instrument to measure fresh fruit and vegetable availability, selection, quality, and
price; mapping food stores located in each community using GIS; training data
collec-tors; and visiting the food stores to conduct the audits We found differences in the
types of food stores present and in the quality of fresh produce for sale, but not fresh
produce selection or prices, among the four communities 34
Examining Health Implications of the Food Environment
The ESVHWP, and later HEP, also initiated new data collection to examine
implica-tions of inequalities in the neighborhood retail food environment for the health of
Detroit residents The ESVHWP added items to a 2001 second - wave survey of African
American women living in eastside Detroit The questions included the name and
location (street intersection) of the primary store where they shopped for food;
percep-tions of the selection, quality, and affordability of fresh produce at that store; and
frequency of fruit and vegetable intake Results of analyses using those data showed
that women with higher incomes were more likely to shop at suburban supermarkets
and suggested that the type of food store to which women had access (using stores
where they shopped as proxies) and the selection and quality of fresh produce for sale
may have infl uenced women ’ s fruit and vegetable consumption 42 Conversations about
the results of this analysis in 2002 among members of the ESVHWP encouraged
efforts to document the demand for fresh fruits and vegetables in the community,
increase the visibility and frequency of the fruit and vegetable minimarkets, expand the
minimarkets to other areas of the city, and work with local store owners to increase
the availability of healthy foods
The Healthy Environments Partnership (HEP) expanded efforts to understand the role of the retail food environment in dietary behaviors and health outcomes among
Detroit residents As part of the National Institute of Environmental Health Science s
Health Disparities Strategic Plan, HEP began in 2000 to examine relationships between
neighborhood social and physical environments and cardiovascular disease risk among
adults in three Detroit communities (eastside, southwest, and northwest) using a CBPR
approach 43