Presenting Author: James E. Bloyd, MPHRegional Health Officer

Community Epidemiology and Health PlanningCook County Department of Public Health

Tuesday November 1, 2011139th Annual Meeting of the American Public Health Association

Washington, DC

Jim Braun Co-President, Illinois Food Farms and Jobs Council, Springfield, Illinois

Orrin Williams Center for Urban Transformation, Chicago, Illinois

Robin Kelly, PhD Bureau of Administration, Cook County, Illinois

Multiple reports describe Chicago area community food environments as important sources of chronic disease and health inequities

Stimulating Supermarket Development in Illinois- by The Food Trust, July 2009, with input from the Illinois Food Marketing Task Force

Illinois Sen. Bill 1221 passed, July 30, 2009. Sect. 200 appropriates $10 million ‘to provide loans and grants for capital-related projects for qualified grocery stores statewide located in underserved communities.’

Conduct a strategic assessment of the development of healthy food financing policy in Illinois

Identify ways to improve implementation of healthy food financing at the federal level and to improve the policy process and implementation in Illinois.

• Semi-structured interviews• 12 interviews conducted: Sept-Oct 2011• Convenience sample, qualitative analysis of

transcribed interviews• Criteria for inclusion: member of Illinois

Food Marketing Task Force; or active as an advocate, food system activist (urban ag, policy involvement, economic development, health)

• Cook County Health and Hospital Systems IRB #11-141

• 8 Task Force Members• 4 Non-task Force Members• By category (respondents in multiple

categories)– Academic 1– Policy All– Business (for profit) 1– Non-Profit 4– Legislative active 3–Government 3– Urban Agriculture 3

• Task Force membership diverse, multi-sector• Learning experience, frank discussions• Achieved goal: legislation passed (SB 1221,

Public Act 096-0039, Section 205) appropriated $10 million

• Negotiations and meetings continue• Recognition that in rural and urban IL

people’s food needs not met• Staff, expertise of The Food Trust; FFF model

“It convened a large group of stakeholders who have the political clout to be able to get the money allocated. If it had not been made up of stakeholders who had political clout the money would not have been allocated.”

“It was a time when the industry and advocates and professionals were able to sit around the table and talk about these issues which, I don't think it happened before, so I think that was very helpful.”

“The overall strength of what came out was getting all kinds of different views, of perspectives of what these barriers are for coming into food desert areas. Like the cost of land… when you go to build a grocery store in an urban area you're talking about purchasing multiple blocks of land,… now you've got streets involved, utilities that have to come into play, and [it] makes it difficult to come into those areas.”

• No participation from people from affected communities

• Lack of follow up, unaware of follow-up• Supermarket industry over represented• Lack of ‘transparency,’ open process• $10 million not adequate• Stalled when The Food Trust ended active

involvement• ‘food desert’ term: inaccurate frame

“The lack of community input I mean we all have different definitions of community but real residents that are impacted by the need for this fund, right? “

“The weakness from my perspective in the task force report is that the task force was heavily stacked with industry people and the supermarket people who were the ones who divested from these communities and caused them to be underserved communities in the first place. “

“They know more about lobbying I assume, maybe it was the way to go, it just surely had an impression of being more bigwig, you know, kind of focused.”

“The biggest is really the capital that is, in reality, is needed …$10 million might build one-and-a-half grocery stores and that is the problem, the biggest hurdle that needs to be overcome.”

• Build infrastructure that increases access to food and also creates social and economic opportunity for local residents

• Authentic input and support from local stakeholders of affected communities

• Leverage $10 mil from phil. and pvt. sources• Advocates should get involved, make voices

heard, community organizing• Implement the program, expedite the process• Group of people now moving the process

again

“Getting the right people investing… who have the experience and knowledge and the wherewithal to be able to come in and to satisfy these needs… to cut out some of the red tape. There's some streamlining that can be done.”

“Authenticity… that it be a participatory process and that it's not driven by policy wonks and that it be a true partnership with the range of stakeholders, and very importantly-- the communities in which this project will take place.”

“I think there is an opportunity to get more of that input, without it having to be revolution or protest, why can't there be more of an inclusive process, when we are trying to create policy that is going to affect people?... the people affected need to be involved at some level.”

“…bring fresh food into the underserved communities while also creating social and economic opportunity that will undermine the underlying factors that have caused them to be underserved communities.”

Lack of relationships at the community level

Top-down implementation Continued disinvestment in African

American and Latino neighborhoods Racism Expense of fresh food Affected communities’ ability to hold

policy makers accountable Challenges to keeping businesses open Bias in favor of large corporations

“I think there are several reasons, one of them is racial, racism, if you look at the pattern of grocery stores in Chicago, there's been some conscious decision-making over the decades to place stores in more affluent communities first.”

“Illinois is a top-down state…There’s certain paternalistic tendencies for people that think that they know what's best for …under resourced, marginalized, disenfranchised communities. So for this to be successful is going to really involve some community organizing.”

“Don’t let the work of the task force just go away. We need to push the work that has been done here and keep it rolling.”

“If we don’t define [it] as part of an overall community development.. An overall goal of ending health inequities, then the threat is we do this and we say ‘All right, food deserts are done, why aren’t these people eating any better?’ and then we go back to blaming. And that’s really a threat.”

Potential for additional themes to arise with more interviews of Task Force Members

No interview with task force staff (The Food Trust)

Review of Task Force minutes would provide additional understanding of participation in the 4 Task Force meetings

Increase rural Illinois and community participation: hearings, forums

Increase transparency◦ Post Task Force minutes online◦ Provide option for public comment

Include broad range of entities at the start; Reach out now.◦ Sources should include: Chicago food policy

groups; New Chicago 2011members; Signers to Oct 25, 2011 Letter to Michelle Obama and Mayor Emmanuel.

Grassroots community organizations drafted a platform including a call to

Create access to affordable, healthy and high quality food that nourishes communities, supports local producers, creates living wage job and fosters economic prosperity.

What does an inclusive policy development process mean to you?

What is the role of governmental public health practitioners in public-private partnerships?

What is the role of racial segregation, and community disinvestment in determining access to food?

How does the WHO social determinants of health framework and recommendations apply to this policy process?

How can Krieger’s eco-social theory of health help public health practitioners understand this policy development and implementation process? (constructs: embodiment, pathways of embodiment, cumulative interplay between exposure, susceptibility and resistance, accountability and agency)

How does the Inst. Of Medicine, others, define policy development as a function of local health departments?

This analysis would not have been possible without the thoughtfulness & generous commitment of time from the participants who spoke to me.

James E. Bloyd, MPH

Cook County Department of Public Health

jbloyd@cookcountyhhs.org

jimbloyd@gmail.com

708 -633-8314

Powerpoint and supporting documents available at www.slideshare.net/jimbloydmph