ShareWhere liquor bottles and advertisements once occupied prime space by the front door of the Daldas Grocery in San Francisco's Tenderloin district, customers now shop for lettuce and carrots.
The Tenderloin is one of many inner city and rural areas lacking healthy food options. There are no supermarkets or grocery stores in those areas. The closest ones are a long walk or several bus rides away.
The closest supermarket to the Tenderloin is a mile away. But there are more than 70 corner stores serving an area of less than half a square mile.
Corner stores typically make their money selling alcohol, tobacco, lottery tickets and junk food. They may offer customers a handful of bananas or apples, but not much else in the way of healthy foods.
The Daldas Grocery, owned by Indian immigrant Satwinder "Bill" Multani, was one of them until public health specialists from the city of San Francisco introduced Multani to a program promoting healthy food options in corner stores. If owners agree to display fresh fruits and vegetables prominently in their stores, San Francisco's Healthy Retail SF program provides display cases, shelving and refrigerators at no cost and teaches customers how to prepare healthy meals.
"It is a very good idea," Multani said. "I know it's actually a positive response because I see more families now and they started shopping for produce."
"It used to be we were just like the image of a liquor store, now we're like the image of a grocery store," he said.
From San Francisco's immigrant-packed Tenderloin to the streets of Baltimore to the rocky coast of eastern Maine, programs encouraging healthy food conversions in corner and rural stores are spreading all over the country.
The task is daunting. Karen Shore, director of consulting for The Food Trust, said millions of low-income Americans buy a lot of the food they and their families eat at "hundreds of thousands" of corner and rural stores lacking healthy food options. In large part, those stores serve African-Americans, Hispanics, immigrant groups and the rural poor.
Based in Philadelphia, The Food Trust is a nonprofit dedicated to providing healthy food to all Americans. It consults with healthy corner store and inner city supermarket initiatives in 34 states, including Healthy Retail SF.
Joel Gittelson, a medical anthropologist at Johns Hopkins University, has studied healthy corner store and bodega initiatives and concluded some have been quite successful, but there is a long way to go.
"We're five percent of the way," he said.
In a report published by the Centers for Disease Control and Prevention, Gittelson studied 16 corner store initiatives in locations ranging from Apache reservations in Arizona to inner city Philadelphia and Baltimore.
"Our findings indicate consistent improvement across most of the trials in availability and sale of healthy foods, the purchase and consumption of those foods and consumer knowledge," he said.
Underlying the healthy corner store movement are concerns about the impact of unhealthy diets on the health of poor Americans. Advocates say both the urban and rural poor, many of whom live below the federal poverty line, suffer high rates of obesity, diabetes and heart disease attributed in large part to unhealthy diets.
Results from older healthy corner store initiatives are encouraging. The Food Trust reported that the Philadelphia Healthy Corner Store Initiative, the first of its kind in the nation, resulted in a 6.3 percent decline in the obesity rate among inner city children.
Successful healthy corner store initiatives are built on three pillars: persuading store owners to participate in the program; providing them with the equipment they need to handle fresh produce; and teaching residents of targeted neighborhoods how to prepare healthy meals. Healthy Retail SF also works with store owners to improve their ability to run a successful business.
Healthy Retail SF has set a goal of reducing the amount of space occupied by alcohol products to not more than 20 percent. Multani said alcohol takes up about 40 percent of the space in his store, but he will reduce that to 20 percent over time.
"We're not telling the owners ‘Hey you need to stop selling tobacco, you need to stop selling alcohol,'" said Jorge Rivas, program manager for Healthy Retail SF.
Added Ryan Thayer, who works with the diverse residents of the Tenderloin for Healthy Retail SF, "Our theory is that over time by increasing the healthy products, there's going to be less demand for alcohol and tobacco."
Thayer and Jessica Estrada work with a group of neighborhood residents they call "food justice leaders." Those residents promote healthy food to their neighbors, encourage them to attend nutrition classes and demonstrations and provide community feedback to program leaders.
"When we do outreach, we have to do it in seven different languages usually," Thayer said.
The Tenderloin is a tasty stew of ethnicities, including Chinese, Filipinos, Mexicans, Hondurans, Vietnamese, Yemenis, Russians, African Americans and others. Diversity means corner stores must respond to the tastes of their customers. Bok choy goes over big in one store; collard greens in another.
Promoting development of supermarkets in the many urban neighborhoods that lack them is a primary goal of the healthy food movement, but for a number of reasons it's slow going.
Small healthy food stores opened in inner city neighborhoods in Philadelphia and Baltimore in recent years but quickly went out of business. Advocates say the owners meant well but failed to connect with members of the community.
"Putting a new store in isn't enough," said Anne Palmer, a food policy advocate at Johns Hopkins University. "It's much more complicated. It's very hard to get all these things working in concert."
The nonprofit Fare & Square market in Chester, Pa., is a new urban supermarket that has succeeded since it opened two years ago. Chester is a struggling city of about 34,000 south of Philadelphia.
Fare & Square is located in an old supermarket that closed 11 year ago. The 14,500-square-foot store, the first nonprofit of its kind, was built by Philabundance, a large hunger relief organization in Philadelphia.
As a nonprofit, Fare & Square is not supposed to make money and it's not. Mike Basher, vice president of retail operations, said revenue increased by 25 percent from year one to year two, but the store is generating only 75 percent of the revenue it needs to break even.
"The board's comfortable with us losing money," Basher said.
One of the raps on corner stores is that they charge higher prices than the big, fancy supermarkets in the suburbs. Healthy corner store advocates said they do everything they can to hold prices down.
"We try and be real aggressive on our pricing," Basher said. "We're always looking for better deals on produce, meats, some of your proteins."
Many corner store customers participate in the federal Supplemental Nutrition Assistance Program (SNAP), which pays for the food they eat.
Basher said SNAP benefits arrive early in the month and tend to run out in the third and fourth weeks. To help its customers deal with that dilemma, Fare & Square created the Carrot Club, which offers customers who say they meet federal poverty guidelines a 7 percent discount on their purchases and an additional 3 percent on fresh fruit and vegetables.
Customers store those savings and draw on them to pay for food at the end of the month, Basher said. "Last year we gave back in Carrot Cash over $140,000," he said. "This year I think we're budgeted for about $165,000."
Inner city corner stores are usually mom and pops owned by immigrants from places like Mexico, Asia or the Middle East. Relations between immigrant owners and residents from different backgrounds can be strained.
Hundreds of stores were looted in Baltimore, including a number of corner stores owned by Korean Americans, when rioting erupted in poor African American neighborhoods following the April death of Freddie Gray while in police custody. A number of those stores participated in the Baltimore Healthy Stores program.
"It was a blow because many of them thought they had a good relationship with the community," Gittelson said. "They felt betrayed."
There may be a growing trend of aspiring food entrepreneurs opening new inner city groceries that fit into the corner store model.
In Seattle, Carrie Ferrence and Jacqueine Gjurgevich opened Stockbox four years ago in a modified shipping container but quickly outgrew it. Stockbox is now located in a 2,000-square-foot building in Seattle's First Hill neighborhood, known locally as Pill Hill because it's been home to several health care facilities.
"Our focus is really about improving access to healthy food inside urban neighborhoods, dairy, meat, milk, veggies and prepared food," Ferrence said. "We put a premium on fresh."
She said Stockbox also stocks items such as chips and soda that are considered junk food.
"One of our commitments is to accept that people like a range of food, and we're not going to put a judgment on it," Ferrence said.
"Our goal is to build a network of smaller grocery stores across the Seattle area, and we're looking at opening two new stores next year," she said.
In eastern Maine, Healthy Acadia, a rural healthy food program touted by The Food Trust, is working on healthy conversions of general stores in two low-income counties, Washington and Hancock. Washington is the easternmost county in the United States; the place where the sun rises first.
Healthy Acadia is focusing on converting rural general stores located more than 20 miles from larger food stores. Access to fresh produce is limited, said Katie Freedman, Healthy Acadia's food programs director, so the program set up a farmer's market in a general store's parking lot over the summer.
Healthy Acadia also received grants from the late actor Paul Newman's Newman's Own Foundation and another foundation to pay for the equipment installed in general stores to display and store produce.
"We're seeing incremental changes," Freedman said. "We haven't seen a major overhaul of these stores. They're not going to become health food stores, but we're seeing a substantial increase in healthy foods. The store owners have been happy with the sales of fresh produce, fruit cups and things like that."
John Van Gieson is a freelance writer based in Tallahassee, Fla. He owns and runs Van Gieson Media Relations, Inc.