Alameda County Nutrition Services Healthy Retail Program

Alameda County is the 7th largest county in California and the 4th most racially diverse county in the United States. 11% of the county's population live below 100% Federal Poverty Level.  

Alameda County Public Health Department's Nutrition Services Program (ACNS), established 20 years ago through SNAP-Ed dollars, envisions that all people live in safe, connected neighborhoods that offer fresh, affordable foods, are choosing active healthy lifestyles and are engaged in their communities. We promote and support healthy eating and physical activity through equitable means including committed partnership with communities to reduce chronic disease and improve long-term health using a health and equity lens.  

Unfortunately, in Alameda County, more than a third of adults are overweight or obese, with trends increasing. Chronic diseases are associated with obesity, including high blood pressure, high cholesterol, type 2 diabetes, coronary heart disease, stroke, osteoarthritis, sleep apnea, respiratory problems, and certain types of cancer. Obesity and diabetes related hospitalizations are also trending higher, creating a negative economic and social emotional community impact. 

Applying an equity lens however, it is clear that certain pockets of communities have even worse health outcomes. In East Oakland, where the Alameda County Healthy Retail Program (HRP) serves, the UCLA Center for Health Policy Research (2015) paints the following picture: 

Adults: 

● 47% obesity rate compared to 23% in Alameda County 

● 31% drink soda 3x/week, compared to 16% in Alameda County 

● 19% consume fruit/vegetables 3x/day, compared to 30% in Alameda County 

● 34% report fair/poor” health compared to 16% in Alameda County 

Children and Teenagers: 

● 30% drank soda/sugar sweetened beverages yesterday, compared to 4% in Alameda County 

● 25% ate five or more servings of fruit/vegetables yesterday, compared to 51% in Alameda County 

● 13% report fair/poor” health compared to 5% in Alameda County 

While a host of public health issues plague East Oakland, one of the primary challenges is healthy food access. Many have called East Oakland a food desert, because residents historically did not have access to affordable, high quality, fresh fruits and vegetables. 

To address this challenge, the Healthy Retail Program set out to change the healthy food access landscape.  HRP has worked in committed partnerships with small neighborhood markets in East Oakland since 2013. HRP employs a host of strategies and practices to change retail environments and address healthy food access, increasing awareness of neighborhood corner stores as places to purchase fresh produce.  

We accomplish healthy retail environmental changes through the following practices:  

1) Building and maintaining meaningful relationships with store owners and community residents 

2) Recognizing and celebrating store owners as community health champions and change agents 

3) Customizing support for each partner store, offering to conduct a range of fun, creative, and culturally relevant interventions and pilots: 

Seasonal Harvest of the Month” food demos and taste tests 

Social media engagement such as Facebook Live and healthy recipe videos 

Installation of healthy signage in produce sections, on shopping carts, aisles, and bulletin boards 

Custom baskets near checkout counters to promote grab and go healthy foods  

Strategic heathy and unhealthy food placement such as moving soda to the back of store and water to the front of the store 

Neighborhood wide Fruit and Veggie Fests”  

Recorded and aired in-store radio ads with nutrition messages 

Placement of life-sized cutouts of medical practitioners from the community promoting produce 

Statewide promotion and support of HRP activities and successes were presented and highlighted by ACNS HRP at the following:  

Retail Program Partner Poster - Statewide SNAP-Ed Conference February, 2020  

Retail Program Policy Poster - Statewide SNAP-Ed Conference February, 2019 

Power Point How to Start a Retail Program - Statewide Retail Meeting, 2018 

Pilot Study to determine if medical provider life sized cutouts influence produce purchasing: Retail Promotion Strategies Nudge Consumers to Buy More Produce - California Childhood Obesity Conference June, 2017 

As store owners learned the value of public health and recognized their own ability to influence community health, they became more invested in promoting fresh fruits and vegetables. In the process, they questioned whether community members would recognize corner stores as a viable place to purchase affordable, quality produce. Partner store owners started to identify issues and problem-solve, resulting in additional successes:  

Increased number of retail store owners annually promoting statewide messaging campaigns: Rethink Your Drink” and Make Every Day a Healthy Snack Day” 

Received two California Department of Food and Agriculture grants to purchase new energy efficient refrigerators for 10 partner stores dedicated to selling California grown produce  

Launched, then expanded the Produce Coupon Pilot Program to lower produce cost and increase access for customers  

Shared healthy retail successes and opportunities with city and county officials to bring attention to small retail store owners as health influencers 

The long-term impact of the Healthy Retail Program is that our partner store owners now champion and promote health with their own customers. Additionally, we incorporated the NACCHO 2019 Model Practice Cooking for Health Academy” graduates into our healthy retail practice.  Our highest level of community capacity building and community engagement is providing community-based income opportunities upon graduation. Community resident champions who graduated from our Cooking Academy partner with us to help our healthy retail stores promote two statewide messaging campaigns. These campaigns reach tens of thousands of fellow community residents.  

The culmination of our Healthy Retail Program practices results in public health impacts such as healthy environmental changes, skill building of leaders and public health change agents, social and economic benefits, and reducing health inequities one corner store neighborhood at a time. We will continue to prioritize underserved areas primarily in Oakland and have already set goals to expand to serve more stores in 2022. Celebrate HRP success at https://acphd.org/nutrition-services/programs/retail/ and highlights at https://acphd-web-media.s3-us-west-2.amazonaws.com/media/programs-services/nutrition-services/docs/acns-healthy-retail-report-201904-final.pdf.  

Alameda County Nutrition Services (ACNS) Healthy Retail Program (HRP) focuses in Oakland. According to the City of Oakland website, Oakland... people of color were impacted by the 1940/50s federal housing redlining policy excluded communities of color from the wealth building opportunity of homeownership. Their neighborhoods were abandoned to urban decay after White flight to the suburbs. Highway 17 (now I-880 or Nimitz Freeway) was built through the heart of the African American community, disrupting community cohesion, and economic viability by cutting it off from Downtown. Many homes and businesses were destroyed to build the Cypress Viaduct and the rest of the Nimitz Freeway.” This description of urban renewal is one of the root causes of healthy food access challenges within the communities the HRP serves. Finding strengths within the community and partnering with store owners as change agents makes HRP unique and innovative.  

Since the inception of  HRP in October 2013, our reach grew from 5 to fourteen stores. We secured additional funding in 2019 to work with community-based organizations allowing the HRP to partner with 24 stores, and extending the reach to additional high need areas of Oakland in 2022. The Healthy People 2030 database shows that healthy retail initiatives are evidence based. 

HRPs community and store owner informed approach is as an evidence-based program model whose objectives are to: 1) Build meaningful relationships with store owners, customers, and community, 2) Recognize owners as Champions of Health and Change Agents in their communities, and 3) Customize support and activities based on each store owner's unique needs.

ACNS celebrates the vibrant communities that contribute to our cultural richness and diversity. We recognize ongoing discrepancies between socioeconomic and racial groups that significantly impact residents' health. To address health disparities, the HRP Team collaborates strategically with corner store owners in neighborhoods of greater need to shift demand, increase access to and consumption of healthy foods, thereby reducing health inequities.

Corner stores are valuable assets in our communities. Alameda County fares worse than the statewide average when it comes to proportion of unhealthy food options, with 4.61 times as many fast-food restaurants and convenience stores as supermarkets and produce vendors. This ratio is just one of many indicators of the lack of availability of fruits, vegetables, and other healthy foods. Additionally, East Oakland residents travel for miles without access to a full-service grocery store making healthy eating a challenge.

Addressing Health Inequities: Addressing health inequities is a long-term commitment and requires being intentional about how we spend our time, money, and limited resources. Over the course of years of partnership, local store owners started to recognize the importance of offering more fresh fruits and vegetables for customers, but they still lacked resources (e.g., funds, staff, time, equipment) to increase and promote them. Although the stores are in neighborhoods with few healthy options, the owners questioned if community members would recognize corner stores as a viable place to buy produce. Building meaningful relationships with store owners and community members in these low-income neighborhoods took time and persistence, especially when results were not immediate. HRP's partnership with small neighborhood markets began in 2013, and although small changes were made to increase access and awareness of produce, additional funding was necessary to make substantial changes that can truly address health inequities.   

Innovation and Solution: Through our HRP, residents in underserved communities in Oakland now have increased access to fresh fruits and vegetables at their neighborhood corner stores. Every step of the journey, we asked our healthy retail store partners if they wanted to try something new, pilot something with us, or go after funding together. We innovated together. We partnered with store owners and leveraged increasing funding from federal, state, and local resources so that we can fund more of the creative ideas about making more sustainable changes in retail environments. Every additional dollar resulted in more innovation and change.

HRP started with only USDA SNAP-Ed funding in 2013, allowing us to conduct cooking demos and taste tests and pass out recipe cards.  By 2019 and 2020, ACNS was awarded 2 rounds of funding from the California Department of Food and Agriculture (CDFA) to purchase and gift 15 new energy efficient refrigeration units to expand the availability of fresh fruits and vegetables, valued at close to $150,000. This was something that our store partners really wanted, and they were willing to have many meetings with us to review grant and refrigeration specifications.

In 2020 and 2021, we leveraged additional funding from the City of Oakland Sugar Sweetened Beverage Tax Revenue to allow us to design a Produce Coupon Pilot Program to increase resident's ability to purchase the produce. Several stores jumped at the opportunity to partner with us in this pilot.

Between March and August 2021, $20,500 worth of coupons were distributed to 7 pilot stores. 4850 coupons were distributed, and 3294 (68%) of those coupons were redeemed to purchase fresh produce. In the co-design of the pilot, we had hoped that as customers used these coupons, they would purchase even more produce. Sure enough, store owners reported that produce sales increased during the coupon pilot, and they are eager to partner with us for additional rounds of coupon distribution.

Sustaining Success: Redemption rates for farmers' market WIC coupons was 48.6 %, whereas this coupon pilot succeeded with a much higher and impressive 68% redemption rate. Based on the pilot program, coupon distribution appears to be an effective and viable way to support community members to consume more produce.  Of 156 customers surveyed in July 2021, 92% said they would like to receive produce coupons in the future.

One customer shared, (This is good) for those who can't get around outside the community for food. There's always been a food desert around here…”

In 2022, ACNS will run another coupon pilot using lessons learned to improve and expanding the number of partner stores up to 20. We will engage new store owners on how to properly store produce and on how to manage the produce coupons to ensure maximum redemption rate. To further understand customers' preferences, ACNS HRP will conduct another customer survey.

ACNS shared produce coupon pilot findings with all Oakland City Councilmembers. The goal is to convince all City Councilmembers to allocate ongoing financial support to fund produce coupons in partner healthy retail stores. Based on our experience and research, coupon distribution is an effective and viable way to support community members to consume more produce.

Centering Healthy Equity: HRP has centered health equity since inception by community engagement beginning with store owners. Over the years, community residents have been brought into the fold. Recently, local residents have played a role in our HPR.  Community resident champions partnered with store owners to promote statewide messaging campaigns.  2021 Summer Interns who grew up in East Oakland worked on the evaluation of HRP's Produce Coupon Pilot Program and had the opportunity to educate and inform local city councilmembers of the impact of the pilot. They shared customer survey responses, and in one particularly powerful and moving response, they reported that a resident was saddened and embarrassed to have to choose cheap, filling, starchy foods instead of fruits and vegetables for her children due to economic constraints.  The produce coupons she received as a result of the pilot program helped her ability to purchase fruits and vegetables at a discounted price.

Because of our role as LHD, we set up a structure that supported equity resulting in a 2019 Healthy Retail Partner convening. Through this, store owners across the partnership met each other and shared best practices. They saw themselves as pillars in the community, learned more about the health disparities that exist, which encouraged them to promote healthy produce consumption and become vocal supporters of the sugar sweetened beverage tax.

The work of HRP is in line with our vision that all people live in safe, connected neighborhoods that offer fresh, affordable foods, are choosing active healthy lifestyles and are engaged in their communities and our mission to promote and support healthy eating and physical activity through committed partnership with communities to reduce chronic disease and improve long-term health. As a program within the Community Health Services Division, Alameda County Nutrition Services established equity goals that 1) work efficiently together for quality and results that advance health and racial equity in Alameda County” and that 2) build capacity internally with staff and externally with partners by bringing equity into our conversations, programs, and practices.

Our equity strategies:  

1.     Purposeful equitable program populations and locations

2.     Quality improvement through formal and informal evaluations, community surveys, and focus groups

3.     Strategic community partnerships

4.     Internal capacity building

Our equity actions that Alameda County Nutrition Services HRP employs are:

Who We Serve:

1.     We prioritize serving communities and groups of people who experience greater negative health disparities based on data as discussed in the overview” section of this application.

2.     We engage and hire Community Resident Champions who are diverse and from the same communities we serve.  When they work alongside us, they have history, knowledge and social capital as representatives from the neighborhoods in which our classes and events are held. HRP practices this.

Where We Do Our Work

1.     A recent grant from the Oakland Sugar Sweetened Beverage Tax Community Grants, prioritized hiring 30 Oakland Resident Champions to co-conduct nutrition education, physical activity promotion, and water promotion interventions throughout priority low-income neighborhoods of East Oakland, San Antonio, Fruitvale, and West Oakland with greater health disparities. These champions conduct nutrition education at Healthy Retail Program sites.

2.     Two additional recent grants from  California Department of Food and Agriculture  prioritized the purchase of new energy efficient refrigeration units for partner retail stores located in lower income neighborhoods, with high percentages of African American and Latinx demographics and low access to full-service grocery stores and affordable healthy food options.  This directly supports the Health Retail Program.

Quality Improvement Frame in Designing and Implementing Our Work in Partnership

1.     We strive for our programs and materials to be linguistically accessible, culturally competent, and generationally appropriate. Many of our educational handouts and materials are translated and available in Alameda County threshold languages. Our workshops are delivered in English, Spanish, Chinese, and Vietnamese as needed. This includes Healthy Retail Program education and marketing.

2.     We regularly seek staff and community feedback both formally and informally during the design, implementation, evaluation and re-evaluation of programs, materials, and services, to see how we can improve even more to achieve equity in our practices and in the communities we serve. The Healthy Retail Program does this through regular contact with store owners.

According to the Healthy Alameda County community dashboard on grocery store density (2016), compared to California counties, Alameda County falls in the second worst quartile of 58 counties. This indicator measures neighborhood grocery store density and the nutrition and diet of residents, putting Alameda County on the downward trajectory. Responding with equitable practices as described above, HRP becomes a better, best-practice grounded in community.

In 2013, the California Department of Public Health's Nutrition Education and Obesity Prevention Branch recognized the importance of providing nutrition education in the corner stores where people shop, and invited Local Health Departments to consider submitting a scope of work that includes healthy retail interventions using USDA SNAP-Ed funds. Considering our limited resources and using an equity framework and data, Oakland became the geographic focus. Five initial stores were onboarded and offered monthly food demonstrations and taste tests using seasonal produce, given recipe cards to distribute.

The Alameda County Healthy Retail Program (HRP) set a goal to address healthy food access in the lowest resourced communities are grounded in these objectives and practices:

1) Building and maintaining meaningful relationships with store owners and community residents

2) Recognizing and celebrating store owners as community health champions and change agents

3) Customizing support for each partner store, offering to conduct a range of fun, creative, and culturally relevant interventions and pilots.

HRP has since become a priority and core practice of focused community engagement, community leadership development, and innovation. HRP team has worked in committed partnership with small corner store owners since 2013, growing from basic trust and relationship building, to capacity building, to each store owner championing health in their stores and becoming community pillars.

LHD Role and Steps: These broad phases occurred over the course of years from 2013 to present, and have included stakeholder engagement along the way.

Phase I: Relationship building which is ongoing, to inform and educate store owners of public health principles, increase their knowledge of fruit and vegetable benefits and harmful impact of sugar-sweetened beverage consumption.  

Phase II: Capacity building of store owners, and committed partnership with them to promote their efforts to achieve healthy changes at their stores, recognizing and celebrating store owners as community health champions and change agents, highlighting their successes locally and statewide.

Phase III: Innovation and expansion through pilot projects and fundraising in a community centered and community engaged way, and always with an eye toward replicating effective practices in other stores and serving additional store partners in the lowest income neighborhoods to achieve health equity.

Phases I and II involve the lead staff, nutrition assistants, community residents, and store owners and policy makers (such as county Board of Supervisors and city councilmembers) as key stakeholders.

Phase III moving forward includes the same key stakeholders a Phases I and II, and adds our NACCHO Model Practice Cooking for Health Academy graduates, community-based organizational partners focusing on community resident and youth engaged healthy retail engagement, and other partner organizations such as the local Yemeni Grocer Association and the ALL IN Alameda County coalition which also works on healthy food access.

Community engagement and partnerships is a core value written into the Alameda County Nutrition Services' program mission statement. Nutrition assistants are on the ground with all of our programs talking to residents and store owners. Many of our staff are also from the communities in which they serve, and all youth leaders and community resident co-educators are also from the communities we serve. ACNS HRP staff have a long history of fostering relationships and serving the lowest income communities following the USDA SNAP-Ed Guidance of >50% of the population must be living at less than 185% FPL.

We fully recognize that meaningful collaboration and long-term engagement is the only way to turn the curve on decades old health inequities in our communities. None of our partnerships are short term. When we design pilot projects, we design them in partnership with our stakeholders. For example, the design and implementation of the entire Produce Coupon Pilot Program is entirely done with store owners' full participation.  They chose the denomination, they chose the redemption conditions, they chose the expiration, and they chose the distribution. By partnering in this way, they are fully invested in the results. Store owners continue to welcome our staff and our interns to conduct assessments, evaluations, etc., which is a great way to talk with shoppers and gather their input on increasing healthy food access.    

Initial estimated startup costs of the HRP in 2013 was $300,000 per year, which covered a part time lead HRP coordinator and 3 part time nutrition assistants.

Our long standing, trusted partnership with community corner store owners paved the way for innovative practices and evaluation opportunities. Store owners have been our primary data source through ongoing dialogue and the use of evaluation tools with the Alameda County Nutrition Services Healthy Retail Program (HRP) team, with surveying customers as the next data source. In 2021, our focus for evaluation was the HRP Produce Coupon Pilot Program.

Produce Coupon Design

 $3, $4, and $5 coupons denominations were printed.

·       Front side: I ❤ California Grown” designed for beauty and to prevent duplication and fraud.

·       Back side: Store name, address, and expiration date with the LHD Healthy Living for Life” and Public Health Department logos.

     Figure 1. Front and back of $5 coupon distributed at Dallaq during the first round

Produce Coupon Distribution

In February 2021, owners of seven stores agreed to participate in the Produce Coupon Pilot Program. Each owner received $3,000 in coupons to distribute to customers as they saw fit. Stores had the permission and freedom to try various distribution methods to determine the most effective modality. Some owners offered coupons when a customer purchased $10 or $20 of produce.  Gazzali's discovered that the best distribution method was for the produce clerk to offer the coupons to customers while shopping in the produce section. The redemption rate of this method was close to 100%. At Rancho Market, coupons were offered at the register and customers were encouraged to purchase the produce immediately, resulting in higher redemption rates. After collecting store owners' feedback, we offered a second round of coupons to capture the unredeemed portion of produce coupons. All seven stores received one new refrigerator and Dallaq received two. Below lists the participating stores and produce coupon amount:

1.     Dallaq- $5

2.     Gazzali's- $5

3.     General Market- $4

4.     Holly Market- $3 and $5

5.     Rancho Market- $5

6.     Royal Foods Market- $5

7.     Supermercado La Raza- $3

Distribution and Redemption Data

This data is accurate as of final collection date- August 5, 2021.

First round

·       Number of coupons distributed- 4950

·       Number of redeemed coupons- 2496

Second round

·       Number of coupons distributed- 1645

·       Number of redeemed coupons to date- 698

Total

·       Number of redeemed coupons- 3194 - 65% coupons redeemed

·       Value of redeemed coupons- $13,329.00 - 63% spent by residents.

Unused

·       Value of Coupons not redeemed - $5,315 - 25%

The design allowed for unredeemed coupons, and we speculate some coupons were tossed, lost, or never redeemed by customers.

Of the original 4950 coupons awarded in March 2021, 2,496 were redeemed. After collecting the initial redeemed coupons, we asked store owners if they wanted to distribute additional coupons to customers to meet their $3,000 goal. Based on store owner's request, we printed an additional 1,645 coupons and distributed the coupons in July 2021 to Dallaq, Royal, General, Gazzali's, La Raza, and Holly. On August 5, 2021, an additional 698 coupons were collected, for a total of 3194 redeemed coupons. We will continue to collect outstanding coupons from La Raza, Dallaq, and General. As of August 5, 2021, $5,315 (only 25%) are not redeemed.

Customer Survey Data

In addition to working with store owners, we also interviewed customers to learn their thoughts about produce coupons. We created and conducted customer surveys to qualitatively measure coupon effectiveness at promoting fresh produce, see survey below. 

Purpose of Survey

1.     Determine if produce coupons increase customer fruit and vegetable consumption

2.     Determine if produce coupon investment significantly increases their produce sales

Survey Questions (Y=Yes; N=No; DK=Don't Know)

1.     Have you seen this coupon before? Y N DK (If no, go to #6)

2.     If yes, did you use it? Y N DK

3.     Did you consume more produce in your diet as a result of the coupon? Y N DK

4.     Would you like to continue receiving produce coupons? Y N DK (if yes, go to #5)

5.     If yes, choose the answer that best describes your reason (choose one of the following)

a.     Produce is expensive and this would help me buy more produce

b.     I would eat more produce if I had more money

c.     I don't like vegetables and wouldn't buy them

d.     I don't know how to cook vegetables and would buy more with this coupon

e.     I don't have the time to cook vegetables so the coupon wouldn't help me

f.      I know vegetables are healthy but I don't know how to cook vegetables

g.     I wouldn't buy more produce because it would just go to waste

h.     I would like a cooking class to help me learn how to cook vegetables

i.      Other_____________________

6.     Would you like a produce coupon? Y N DK

Surveys were conducted at all locations over a three-week period and received input from 153 customers.  Below lists the percent of customers surveyed at each store. The majority of respondents were from Gazzali's because it is a larger store with more customer activity.

1.     Dallaq- 6.54% - 10

2.     Gazzali's- 41.19%- 63

3.     General Market- 9.15%- 14

4.     Holly Market- 6.54%- 10

5.     Rancho Market-15.3%- 23

6.     Royal Foods Market-9.80%-15

7.     Supermercado La Raza- 11.76%- 18

Summary of Customer Survey

Of 153 customers surveyed, 22% (34 people) reported previously seeing the coupons. Of those participants, 43% (14 people) used the coupon. When asked if this influenced their fresh produce consumption, 47% (7 people) reported yes. Since the numbers are so small, it is not possible to extrapolate, though it is a positive measure. The most significant finding was that 92% (131 people) said they would like the coupon. In addition, customers shared their thoughts about the produce coupons and eating healthy. Below are a few customer comments:

●      (This is good) for those who can't get around outside the community for food. There's always been a food desert around here… (This is a) historically underserved community.”

●      Not everybody can afford fruits and vegetables.”

●      My daughter told me today we don't have healthy alternatives. How do you think that made me feel? We want to eat better but if prices are high, it's difficult. Hungry or unhealthy?”

●      Vegetables are expensive… more expensive than packaged snacks and junk food.”

●      Convenient for people in this area, no stores that are walking distance and convenient.”

●      Tough out here for the community, easier on everyone. (The produce coupon) brings people hope.”

Literature Review Confirms Benefits of Coupons

The HRP team conducted a literature review and affirmed that the pilot Produce Coupon Initiative is a viable strategy:

1.  Two-for-one deals most effective with customers (Tripp, 2015)

2. Consumers are more likely to respond to a coupon than the equivalent price reduction of a product (Cotton & Babb, 1978)

3. Recommendations for issuing coupons include manipulation of other aspects of coupons such as: a. varying face value, b. physical versus online coupons, c. brand awareness/previous exposure, d. use of visuals. (Tripp, 2015)

4. Coupons have been thought to be effective in tempting prospective consumers to try new products as well as a reward to loyal customers for their continued patronage. Research suggests the higher the coupon value, the higher the incentive for consumers to purchase (Kendrick, 1998)

5. Coupons are more effective than price-discount/other non-coupon promotions in increasing fruit and vegetable purchases (Dong & Leibtag, 2010)

Conclusion and Next Steps

Based on our experience and research, coupon distribution is an effective and viable way to support community members to consume more produce. $21,000 was invested in the community through our partner stores, and to date, customers have purchased $13,329 in produce in underserved neighborhoods, primarily Oakland. Based on HRP engagement in the community and feedback from residents, economic support for residents is key to ensuring produce consumption. Literature confirms that offering coupons incentivizes customers to buy more of a product. Gazzali's store owner, Mike Algazzali, confirmed sales increased during produce coupon dissemination.

Because of the evaluation results, ACNS HRP is committed to one more round of this pilot and include additional healthy retail partner stores in 2022. Simultaneously, we are collaborating with the City of Oakland's 7 Councilmembers and the City Administrator to garner the ongoing support of healthy retail work. If a city budgetary allocation is made, the funds in essence would go directly to low-income Oakland residents to purchase fresh produce in small retail stores. To ensure proper distribution of coupons, Alameda County Nutrition Services commits to the oversite of the program. ACNS would provide an annual report on the produce coupon project to City Councilmembers. We have identified stores in each City Council district. Not only would this help community members eat healthier but would reinforce positive relationships between Oakland small business owners, residents, and local city officials: a win-win-win!

As HRP grows and evolves, we continue to find ways to study the impact of our work. In fiscal year 2020, we launched a new retail environment assess tool developed by UC Berkeley to gather baseline data on all partner stores.  Moving forward we will use this tool once a year to measure the amount of change that happens in the retail store environment in a quantitative way and collaborate with UC Berkeley on analyzing the results. The results will be used to collaborate with store owners to make further improvements to increase accessabilty of fresh produce for the community.

References

1. Alexander V, Tripp S, Zak PJ. Preliminary evidence for the neurophysiologic effects of online coupons: Changes in oxytocin, stress, and mood. Psychology & Marketing. 2015;32(9):977-986

2. Cotton, B. C., & Babb, E. M. Consumer Response to Promotional Deals. Journal of Marketing, 1978 42(3), 109113.

3. Kendrick, A. Promotional Products vs Price Promotion in Fostering Customer Loyalty: A report of two controlled field experiments. Journal of Services Marketing, 1998. 12(4), 312326.

4. Dong, D & Leibtag, E. USDA. Promoting fruit and vegetable consumption: Are coupons more effective than pure price discounts? 2010

We are seeing benefits of the Healthy Retail Program (HRP).  Alameda County Public Health Department's Nutrition Services Program (ACNS) and HRP have received direct feedback from store owners that they are fully vested in the goals. To support the objectives, for example, strategies for sustainability have been taken to engage stakeholders to realize the fruits of the investment. In previous years, ACNS paid for produce at taste tests, Fruit and Vegetable Festivals, Rethink Your Drink Day, and Healthy Snack Day. In 2021, store owners took responsibility and offered financial resources to support promotion of fruits and vegetables. For example, during Healthy Snack Week in October 2021, Rancho Market offered free delivery of apples to participating stores who had difficulty getting tasty apples. Royal, Holly, Dallaq, Gazzalis, and La Raza were willing to pay for a case of apples to offer to their customers for Healthy Snack Day.  

Since CDFA awarded 15 refrigeration units to our partner stores, we have engaged with Board of Supervisors and City Councilmembers to participate in ribbon cuttings of the new energy efficient produce dedicated refrigerators.  Increased awareness of the struggles of small corner store owners have started a dialogue with local officials about how to support the store owners and increase healthy foods in underserved areas of Oakland and neighboring cities.   

In 2019, the inaugural Healthy Retail Convening was held. All store owners were invited to attend, however, many were unable to attend due to the difficulty of store staffing. This was the first gathering of small store owners, resulting in networking among store owners, public health staff, and local officials. Our retail team shared resources and answered participant questions of concern, such as the soda tax and required fees. The evaluation results suggested that it was valuable and the consensus was an annual meeting. We are planning a 2nd retail gathering in October 2022.  

Following the refrigeration deliveries, the next hurdle was to promote produce availability in the corner stores which lead to the produce coupon pilot. With the completion of the Produce Coupon Pilot, the report was shared with all Oakland City Councilmembers and to date we have met with six of seven city councilmembers to share results and ask for guidance and financial support. In 2022 HRP will launch a second round of produce coupons, applying lessons learned and suggestions offered from city councilmembers.  

One City councilmember suggested presenting the produce coupon report to the Soda Tax Advisory Board, who recommends to Oakland City Council which projects are worthy of financial support of Oakland soda tax fund. HRP is on the agenda to present to Soda Advisory Council in February 2022.  

Lastly, HRP identified a long-term partner Rancho Market as a potential produce distributor to small corner stores that don't have the flexibility to regularly buy produce.  Rancho agreed to meet this challenge so ACNS facilitated the award of a refrigerated truck and walk-in refrigerator to house more produce for the delivery to small stores in and around Oakland. Rancho is poised to begin outreach with our support.  

Another barrier for small corner stores is not having Point of Sale Equipment to track their inventory due to expense and technical knowledge. One of our partner store owners recently purchased a POS system for small corner stores and is willing to share his knowledge with other partner store owners.  

Community Engagement has involved our local health champions who have supported activities at partner stores for RTYD and Healthy Snack Day. 

That same year, resident champions began staffing the annual the statewide Healthy Victory Campaigns – Rethink Your Drink and Healthy Snack Day – modeling a two-tiered champion approach to activating the corner stores. This strategy will continue in 2022. 

In the past year, newly established relationships with City Councilmembers strengthens our position to garner support for small corner store owners, thus ensuring healthier foods reach community members in underserved neighborhoods. We will continue to learn from our lessons to improve the program, and continue searching for new financial opportunities to continue supporting our partner store owners. 

Cost Benefit: Reflecting on the level of success of our practice and analyzing it against the amount of funding we invested, HRP could not be more proud of the results.   

Estimated Costs: Funding for the ACNS Healthy Retail Program over the years included: 

Federal USDA funding for lead coordinator and three nutrition assistants from 2013-present. ~$300,000 per year, considered our startup costs. 

State CDFA funding for refrigeration and technical assistance from 2019-2020. ~$150,000 over 2 years. 

County Measure A Obesity Prevention funding a health retail manager and two community-based organizations from 2019-present, for youth and community engagement. ~$300,000 per year. 

City Sugar Sweetened Beverage Tax Revenue Community Grants funding for community outreach. ~$250,000 over 2 years. 

Estimated Benefits:  

Environmental changes in partner stores that are here to stay for the long run:  

Moving soda to the back of the store  

Moving water to the front of the store 

Healthy checkout counters 

New refrigerators dedicated to selling California grown produce 

Unique pricing strategies to promote the purchase of healthy items 

Literally increase real estate in the store to stock healthy items 

Coupons considered cash in the hands of low-income shoppers to purchase fresh fruits and vegetables of their choice, increasing likelihood of consumption 

A cadre of community leaders promoting health and good nutrition, multiplying our message 

In kind contributions of store owners as they become more and more invested in promoting health themselves, giving of their time and resources on their own initiative 

Community members benefit with increased access to healthy foods 

The early financial investments result in benefits for years to come because of the nature of changing the healthy retail environment and making these changes sustainable because store owners see the value and are fully bought in!