Improving Access to Fresh Fruits and Vegetables in New York City
Evidence shows that healthy eating patterns are associated with positive health outcomes, including a reduced risk of cardiovascular disease. One of the key recommendations of the Dietary Guidelines is to follow a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level, including a variety of vegetables. Having access to healthy, safe, and affordable food choices is crucial for an individual to achieve a healthy eating pattern. Food access is influenced by diverse factors, including proximity to food retail outlets (e.g., distance to a store or the number of stores in an area), individual resources (e.g., income or personal transportation), and neighborhood-level resources (e.g., average income of the neighborhood and availability of public transportation). Race/ethnicity, socioeconomic status, geographic location, and the presence of a disability also may affect an individual’s ability to access foods to support healthy eating patterns.1
Food access is important in all settings where people make choices. Improving food access in settings such as schools, worksites, early care and education programs, and food retail may include changing organizational policies to improve the availability and provision of healthy food choices, developing or updating nutrition standards for food service operations, and educating customers about how to identify healthy choices, such as through point-of-purchase information. Innovative approaches are emerging to improve food access within communities. These include creating financing programs to incentivize grocery store development; increasing the availability of foods to support healthy eating patterns in retail outlets, including corner stores, bodegas, farmers markets, mobile markets, shelters, food banks, and community gardens/cooperatives; and creating new pathways for wholesale distribution through food hubs.1
To improve fruit and vegetable consumption in New York City, the New York City Department of Health and Mental Hygiene (NYC DOHMH) uses a social-ecological model to support complementary programs designed to increase fruit and vegetable consumption throughout NYC.2 Retail access has been a focus for the NYC DOHMH, which has developed approaches to impact various types of retail, including supermarkets, farmers markets, bodegas (corner stores), and street vending. Some initiatives implemented directly by the NYC DOHMH include new street vending permits for Green Carts, the Health Bucks program, Healthy Bodegas (Shop Healthy), nutrition education in various settings, and interventions implemented in supermarket settings.3
In 2008, Mayor Michael Bloomberg and the NYC City Council signed legislation for Local Law 9, which established 1,000 permits for a new street class of food vendors called Green Carts as part of a city-wide effort to increase the consumption of healthy foods throughout NYC, particularly in low-income neighborhoods. Green carts are mobile food carts that sell whole fresh fruits and vegetables in target neighborhoods with low levels of fruit and vegetable consumption. These designated neighborhoods were deemed eligible for the Green Carts initiative when at least 14% of survey respondents indicated they had not consumed fresh fruits or vegetables in the previous day.4 Each of the city’s 5 boroughs was allotted a specific number of carts that could move freely within areas where the consumption of fruits and vegetables is low and where the prevalence of diet-related diseases is high. To support the program, the administrative Health Code was amended by the Commissioner of Health and Mental Hygiene to allow new mobile produce vendors.5 In addition to the existing mobile food vending license and food-safety course, vendors were required to obtain a new, borough-specific Green Cart permit.6
As a result, the Green Carts Initiative led to an increase in new job opportunities and the introduction of fresh fruits and vegetables in areas where produce consumption was low.7 Findings from a study conducted by the NYC DOHMH indicated that the proportion of food retailers (supermarkets, small grocery stores, fruit and vegetable stores, bodegas, and mobile carts) that sold fresh produce and/or a larger variety of produce increased in areas with Green Carts.8 Between 2002 and 2012, the prevalence of NYC adults who reported consuming no fruits and vegetables the previous day declined from 14.3% to 12.5%.3 The percent of stores selling both fruits and vegetables in Green Cart areas increased from 50% in 2008 to 68% in 2009, and this increase was maintained in 2011 (69%).8 A 2014 study found 71% of Green Cart customers increased their overall consumption of fruits and vegetables.9 As a result, various projects and initiatives implemented throughout NYC, including Green Carts, have helped foster an increase in the availability of fresh fruits and vegetables in areas of the city with the greatest need.10
In addition to the Green Carts Initiative, the Healthy Bodegas (Shop Healthy) Program was founded in 2006 by the NYC Center for Economic Opportunity in partnership with the NYC DOHMH to collaborate with bodegas (corner stores) to support environmental changes to help stores promote healthier items.11 In 2009, NYC DOHMH conducted a program evaluation examining 60 of the bodegas that had received assistance through the program by distributing surveys to store owners and consumers. Analysis findings showed that shop owners made an average of about 4 health-promoting changes to their business, including an increase in fruit and vegetable options.11
Finally, the Health Bucks initiative is a farmers market coupon incentive program to increase fruit and vegetable consumption among low-income New Yorkers. The NYC DOHMH began distributing Health Bucks in 2005 and now distributes almost $1 million in $2 increments as Supplemental Nutrition Assistance Program (SNAP) incentives and through community-based organizations. Organizations and elected officials can also purchase Health Bucks for distribution. Each Health Buck coupon is redeemable for fruits and vegetables at farmers markets across NYC. Health Bucks users report that the coupons make them more likely to buy fresh produce, and farmers market managers reported that new customers shop at the market more often and more repeat customers come to the market because of Health Bucks.12
The NYC DOHMH will continue to track fruit and vegetable consumption and related indicators, as well as monitor existing programs. The NYC DOHMH’s ongoing goal is to decrease chronic disease rates, and work to increase access to fruits and vegetables plays an important role in this effort.
1 U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th edition. December 2015. Available from: http://health.gov/dietaryguidelines/2015/guidelines/
2 U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th edition. December 2015. Available from: https://health.gov/dietaryguidelines/2015/guidelines/chapter-3/social-ec...
5 Commissioner of Health and Mental Hygiene. Notice of Adoption of Amendments to Chapter 6 (Food Units) of Title 24 of the Rules of the City of New York. New York City Department of Health and Mental Hygiene. 2008;1–3. Available from: http://www1.nyc.gov/assets/doh/downloads/pdf/notice/notice-adoption-chapter6.pdf
6 New York City Department of Health and Mental Hygiene [Internet]. Green Carts: Becoming a Green Cart Vendor. [cited 2016 July 15]. Available from: http://www1.nyc.gov/site/doh/health/health-topics/green-carts-vendor.page
7 CDC. State Indicator Report on Fruits and Vegetables, 2009. Available from: http://www.cdc.gov/nutrition/downloads/StateIndicatorReport2009.pdf
10 Leggat M, Kerker B, Nonas C, Marcus E. Pushing Produce: The New York City Green Carts Initiative. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2012;89(6):937–938. doi:10.1007/s11524-012-9688-4
12 Payne GH, Wethington H, Olsho L, Jernigan J, Farris R, Walker DK. Implementing a Farmers’ Market Incentive Program: Perspectives on the New York City Health Bucks Program. Prev Chronic Dis. 2013;10:120285. doi:http://dx.doi.org/10.5888/pcd10.120285
Green Carts Initiative
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