Though I grew up in Roxbury, “the heart of Black culture in Boston,” I now live in Los Angeles, where I typically shop for groceries at Whole Foods Market or Trader Joe’s. Their produce is fresh, green, abundant. Organic options beckon as you walk in the door.

So it gnawed at me, a Black woman, when I recently walked into a supermarket in a lower-income L.A. neighborhood and was greeted instead by an array of processed, high-sugar, high-sodium foods — often offered with a nice discount: Coca-Cola products, five 2-liter bottles for $5; sugary cereals, two for $4; boxed brownie and cake mixes, four for $5.

The pandemic had underlined long-standing health disparities of Black and brown communities. Covid had resulted in a 2.9-year decrease in life expectancy for Black Americans, compared with 1.2 years for white Americans. Research had consistently shown that among the underlying factors giving rise to those poor health statistics — high rates of diabetes and heart disease, for example — is poor diet, fueled by a lack of healthy food options in their neighborhoods.

“I could go into a supermarket, and I can tell everything about the people who live [in the area] based on what’s in their carts, based on what’s at eye level, what’s not at eye level,” said Phil Lempert, also known as the “Supermarket Guru.”

In retail, specific product placement — not just a store’s inventory — heavily influences a shopper’s experience. So shouldn’t responsible markets encourage shoppers to make better choices?

“There’s a lot of racism, to be honest, I think, behind these decisions, whether it’s unconscious or implicit,” said Andrea Richardson, a policy researcher focused on nutrition epidemiology at the Rand Corp. and professor at the Pardee Rand Graduate School. The presence of a supermarket in your neighborhood should signal that you aren’t living in a food desert, but, I wondered, if the supermarket isn’t guiding you toward more healthful food choices, you might as well be.

Chaseedaw and Lilie’s Shopping List

– Oat milk
– Lettuce
– Ezekiel bread
– Breakfast sausage (MorningStar)
– Fruit
– Cereal
– Cashew cheese
– Quinoa
– Snacks/chips
– Soda/juice
– Meat (fish)
– Mushrooms

So when I flew home for Thanksgiving, I enlisted my mother, Lilie — who always cared about her kids’ diets — to help with more research. I have vivid childhood memories of her scouring multiple grocery stores — often traveling to different parts of town — for the freshest ingredients when none were available close by. We set out one Sunday last fall to buy 12 items on a simple “healthy eating” shopping list at five locations of Stop & Shop, a supermarket chain with stores in a cross section of Boston neighborhoods.

First the good news: We were able to find every item we wanted at each store. But, just as I’d experienced in L.A., healthy foods were easier to find in higher-income neighborhoods. In lower-income areas, junk food was more likely to be front and center.

At the Stop & Shop I recall from my childhood in Jamaica Plain, the food choices had become much more balanced, with a plentiful organic food section in the front of the store. My mom can now buy fresher greens locally.

But that likely in part reflects the gentrification that has taken place since I was a kid. Jamaica Plain now has a median income of almost $77,000 — though the poverty rate is 18.3% and the aroma of Dominican and Haitian patties still scented the air as we approached the entrance.

Our next two stops were in even fancier areas, Brookline (median income over $115,000) and Somerville — both green oases compared with many of Boston’s grittier neighborhoods.

At the Brookline location, each aisle started with low-fat, low-sugar choices like Crystal Light and V8, and the candy section was minuscule. In Somerville, the produce section was spacious, leaving plenty of room to browse the bins of guava and dragon fruit.

Our next Stop & Shop was in South Boston — a working-class, Irish Catholic community. It was strikingly different than our first three stops. The organic section consisted mostly of breakfast bars and cereals. The produce section positioned caramels, candied apples, and pumpkin-spice doughnuts in a bin alongside regular apples — at the bargain price of two packages for $3. The “International Foods” aisle sold everything you need for a very American Taco Tuesday, while a big part of this section was dedicated to Italian and Irish foods.

In the Grove Hall neighborhood in Dorchester — a predominantly Black neighborhood with a median income of $55,000 — the offerings were downright dispiriting.

Soda was displayed prominently near one entrance. And as we walked the aisles it seemed that many of the “sale” items were sugary soda products, chips, or cookies. This store had a dizzying array of snack food options, including 20 kinds of Oreos. And there wasn’t an organic food section at all.

The chain has been “doing a lot of work” to make sure that stores are “culturally relevant and [reflect] the demographics of the neighborhood,” said Jennifer Brogan, director of Stop & Shop’s corporate external communications and community relations.

How a store is stocked depends on size, product movement, shelf size, and a mixture of customer feedback and data. That data comes from companies like IRi, a research company, that provides consumer, shopper, and retail market intelligence and analyses.

Lempert, the “supermarket guru,” further explained that companies and brands pay retailers “promotional dollars” to put their goods “at eye level” or on sale, or make them available for consumers to sample.

But in making these largely commercial decisions, markets make it more difficult for people in low-income areas to eat healthfully, encouraging those with poor diets to continue the habits that landed them with diet-related illnesses.

“It has been well documented that junk-food companies spend significantly more money advertising in certain communities,” said Kelly LeBlanc, director of nutrition at Oldways, a Boston-based food and nutrition nonprofit. A 2019 report, for instance, found that junk-food advertising disproportionately targeted Black and Hispanic youth.

Stop & Shop has started to try to redress the inequity, with changes coming first to its Dorchester location, including an in-store dietitian. The Grove Hall store also sends out an ad circular that features promotional pricing on better-for-you items, which may include fish, vegetables, and fruit. It has joined the Fresh Connect food prescription program that allows participating doctors to prescribe to patients a prepaid Visa card that can be used to purchase fruits and vegetables.

Still, why not simply cut down on the soda and bewildering number of Oreos, I wondered. “I think our job is to give customers a choice,” Brogan said. “I also think we have a responsibility to help them make healthier choices.”

I’m glad my mom taught me how to make those choices early on.

Another thing I learned: There’s a whole science behind how supermarkets are organized, and depending on where you live, that could say a lot about the surrounding area. So the next time I think about moving, the first place I’m heading to is the local supermarket because, as Lempert told me, “going to that community grocery store is going to tell you about the neighborhood.”

[This article was published by Chaseedaw Giles both in The Boston Globe and on KHN News and is republished on Medika.Life with permission.]

The post What Does It Say About Your Neighborhood If the Supermarket Isn’t So Super? appeared first on Medika Life.

Among the problems that the pandemic has drawn attention to is the high prevalence of underlying chronic health conditions in the U.S. population. These conditions — including obesity, diabetes, high blood pressure and cardiovascular disease — are more than contributors to worsen COVID-19 outcomes; they are also a growing long-term threat to the country’s health, productivity and national security.

According to the Centers for Disease Control and Prevention, 88 million American adults (1 in 3) have prediabetes, 60% of adults in the U.S. have a chronic disease and 40% have more than one, and these chronic diseases are the leading drivers of America’s soaring health care costs ($3.8 trillion in 2019).

The COVID-19 pandemic grabbed our attention because the impact was immediate and we all felt at risk. Even most people who were not personally concerned about the danger to their own health were at least conscious of the risk of coming into contact with the virus and needing to quarantine or, worse, passing the virus on to someone more vulnerable. We responded quickly to this new infectious disease and became hypervigilant.

It’s time to transfer some of that same urgency to addressing chronic noncommunicable diseases. Pre-COVID, noncommunicable diseases were responsible for nearly 90% of deaths in the U.S. While provisional data from the CDC identify COVID-19 as the third-leading cause of death in 2020, the first and second were heart disease and cancer, respectively, with stroke, chronic lower respiratory disease and diabetes also in the top 10.

Many of these diseases (and the physical, mental and economic costs they entail) are preventable. The World Health Organization states that eliminating the four major behavioral risk factors for chronic disease — unhealthy diets, physical inactivity, tobacco use and harmful use of alcohol — would prevent 80% of all heart disease, stroke and type 2 diabetes and 40% of cancer.

In many ways, the rising tide of chronic disease is similar to the issue we face with climate change: while we all recognize that it’s serious, and we know we need to act, because the impact is not immediate it’s hard to overcome inertia and introduce the significant structural changes that would really make a difference.

COVID-19 generated a burst of attention for communicable disease, but there’s no equivalent pressure forcing immediate action on noncommunicable disease. Social scientists and psychologists who study risk perception have long observed how we react strongly to sudden, acute risks (say, a wildfire bearing down on our town) but become habituated to chronic, ongoing threats (gradual warming of the planet or the risk of car accidents, for example).

But we don’t need to become desensitized and accept a high level of chronic disease and its spiraling costs to health insurers as inevitable. The pandemic proved that both individuals and organizations can change their habits to protect people’s well-being.

President Biden’s recently proposed American Families Plan includes a variety of provisions aimed at reducing the financial impact of illness and making health care more affordable, such as the establishment of a national comprehensive paid family and medical leave program and reducing health insurance premiums and deductibles for those who buy coverage on their own. However, with roughly half of Americans obtaining their health insurance through their employer, significant efforts are needed to decrease corporate health care costs as well.

If we really want to reduce costs, we need to tackle the problem at its root by reducing the need for care. We must take a step back and look for ways to support early intervention before people develop preventable chronic conditions.

The COVID-19 pandemic has primed corporate America for a mindset shift in terms of health care plan design and benefits. Companies recognize the need to place a higher priority on employee health and wellbeing, and Congress should offer tax credits to incentivize organizations to turn these good intentions into reality.

Encouraging the adoption of proven evidence-based preventive care benefits that address unhealthy behaviors before they lead to chronic disease will have a much greater long-term impact than tinkering with the edges of condition management for the health insurance market.

We can’t let complacency set in as soon as the pandemic is over, because business as usual is unsustainable and threatens America. Let’s leverage the lessons learned from COVID-19 to prevent both communicable and noncommunicable disease — after all, there is only one health we need to safeguard. We must act now to help keep the American workforce healthy, reduce employer health care costs, and prevent the increasing incidence of chronic disease from overburdening the health care system and the economy.

The post It’s Time to Apply COVID-Scale Urgency to Noncommunicable Diseases appeared first on Medika Life.