Low-income areas struggle to access healthy food

Caroline Washington of Schenectady, left, gives a fork full of rice, chicken, and vegetables to her 19-month-old grandson, being held by his mother, Elizabeth Washington, 19, with Mary Clifford of Cornell Cooperative Extension, center, at the Bellevue ...

For three summers in a row, Vickie Hurewitz stood behind a produce stand on a main drag in Schenectady’s Hamilton Hill neighborhood and tried to sell fresh fruits and vegetables.

She had cherry tomatoes, watermelon, potatoes, broccoli, cauliflower, corn, lettuce, cabbage, eggplant and red and green peppers. For 75 cents a pound, someone could grab a pound of peaches. Fresh-picked strawberries went for $1.50 a quart. As autumn arrived, she’d bring out apples and butternut and acorn squash.

“I could accept food stamps, but it still didn’t generate any customers,” said Hurewitz, a volunteer with Better Neighborhoods Inc. who once lobbied to get a grocery store in Hamilton Hill. “It just never took off, and it was the weirdest thing. I don’t know why they didn’t buy the stuff. It was high quality. It was cheap. I believed in the project. I believe that price should not be a burden for people trying to eat healthy. But after three years of losing money, I had to shut it down.”

Large swaths of Schenectady are considered food deserts — places without ready access to fresh, healthy and affordable food. For a long time, it’s been assumed the lack of access to fresh food — especially among low-income populations — is a major contributor to poor diet and higher levels of obesity, diabetes and heart disease.

But more and more researchers are finding the food desert explanation for obesity may not be quite right, that actually it’s the stresses of poverty itself that make people sick. Long-favored solutions such as farmers markets, big-box supermarkets and other initiatives don’t seem to be working by themselves. Even when fresh produce is made accessible and cheap, the poor are bypassing it for more familiar items such as soda, chips and other high-calorie, over-processed foods.

Schenectady, with its high rates of diabetes and obesity, seems to be catching on. It’s no longer just throwing healthy food at certain populations, but providing education, as well. Getting people to eat healthier, local officials say, may become a lot easier if they are given some basic knowledge about how to cook and prepare meals in a way that fits into their lifestyle.

“If you come across a bunch of kale and you don’t know what to do with it, you’re not going to buy it or eat it,” said Jacquie Hurd, president of the Bellevue Preservation Association. “But if you have a recipe and someone takes the time to show you how to prepare kale and use kale, the possibility is higher that you may actually consume it.”

Her organization successfully lobbied to get a farmers market up and running in the city’s Bellevue neighborhood, where lower-income residents often walk to the nearby Bonfare and Dollar General for their food. On Thursday, the Bellevue market launched its third summer season with the help of a state grant.

The market has put a dent in the neighborhood’s food desert problem, Hurd said, although she thinks the neighborhood could still use a permanent urban supermarket. But one afternoon a week, the small farmers market accomplishes its goal of providing healthy food within walking distance for residents. And from 2012 to 2013, food stamp sales tripled.

This year, Cornell Cooperative Extension of Schenectady County will host several cooking demonstrations at the Bellevue market to give people an idea of how to cook produce that may have been foreign to them.

“If you’ve grown up with fast food or junk food as your frame of reference, then your view of food is very limited,” Hurd said. “That’s one of the reasons we want to do the cooking demos. We also want to have a community table that hands out recipes or just talks to people about, say, how to use Swiss chard. You can make an absolutely phenomenal pot of Swiss chard that feeds a family of four for a week.”

In recent years, a number of studies and agencies have determined food deserts aren’t as big of an issue as everyone thought.

A 2012 Social Science & Medicine study found that, on average, poor neighborhoods with obesity epidemics actually have more grocery stores than wealthier neighborhoods. Another study that year by the American Journal of Preventive Medicine found that, among California youth, there was no “robust relationship” between food consumption and the level of exposure to fast food, convenience stores or supermarkets. A 2011 study by the Journal of the American Medical Association concluded that increasing access to healthy foods isn’t enough on its own, that it may require complementary or alternative strategies to promote dietary behavioral change. The answer to health disparities, these studies say, seems to have less to do with access and much more to do with priorities.

A February article in Slate put it this way: “Researchers who focus on health disparities have suspected for decades that people who live in poverty die early because of the stress of poverty itself rather than the poor health choices low-income people make. That’s not to say that poor people don’t make decisions about diet and exercise, but in general they are preoccupied with very different choices than wealthier people are: Should I pay my electricity or my water bill? Can I pay my rent and buy my kid a pair of school shoes? The immediacy of these pressures may make it more difficult to think about how eating choices today will affect health 10 or 20 years from now.”

Sarah Pechar, interim executive director of Cornell Cooperative Extension of Schenectady County, witnessed poor, obese people in Schenectady refuse to eat fresh fruits and vegetables offered to them last year, free of charge. She oversaw a new program called HealthShares that had doctors at Ellis Medicine’s McClellan Street campus hand out prescriptions for free fruits and vegetables to low-income patients suffering from chronic obesity or heart conditions. The produce came from the city’s greenhouse in Central Park and could be picked up at Ellis’s McClellan campus, right in the heart of a needy neighborhood.

Half of the 100 patients enrolled in the program dropped out.

“We had people that maybe came the first week, and we never saw them again for whatever reason,” Pechar said. “We had participants who gradually dropped out over the course of the summer. We had some people who moved away or didn’t have gas in their car one week or couldn’t get a ride. And we had people who said, ‘Sorry, this just isn’t going to work for me. My family isn’t going to eat this food.’ Clearly, fresh produce wasn’t a priority to them or it just didn’t fit into their life at the time.”

For the roughly 50 participants who stuck with it, though, the results were exactly what everyone had hoped for. Whenever patients came to pick up their vegetables, they were given nutrition education on topics like portion sizes and using herbs instead of salt for flavoring. Many people didn’t even know they could use food stamps at the Schenectady farmers markets.

In one extreme example, 63-year-old Elaine Young lost 100 pounds in just under a year by incorporating the doctor-prescribed veggies into her diet. Pechar suspected this had something to do with her childhood recollections of healthy foods.

“I had a Polish grandmother, and every weekend when I was young we made soups and stews,” Young said. “We’d take the leftover bits and pieces of squash from the week and we’d throw them in the pot.”

As an adult, Young had trouble incorporating fresh vegetables into her diet. She lives in Altamont, where it takes her anywhere from 20 to 45 minutes to get to a big supermarket, depending on whether she goes to Schenectady or Guilderland. So grocery shopping became a once- or twice-a-month errand where she stocked up on canned foods and things that would last until the next trip.

Last summer, at more than 300 pounds with diabetes and heart troubles, she visited her doctor, who wrote her the strangest prescription she had ever been given. “She said, ‘I don’t think you’re getting enough vegetables. This will introduce you to new ones.’”

Every two weeks, she drove to Schenectady and picked up a bag full of arugula, kale, chives, scallions, red and black tomatoes, purple and white eggplant, yellow squash and more. She learned how to make the food last longer by chopping up the stuff she wouldn’t use one week, freezing it and then thawing it for stir fry or side dishes the next week. She even got her 17-year-old grandson into it.

“They were different foods for him,” Young said. “He’d never seen them before. We tried the kale in soups and stews, salads and spaghetti sauces. We baked them in the oven one day to make kale chips and they were a big hit. He’ll try anything once and now he’s hooked.”

Several programs that have trickled into the city are designed to expose people to healthy foods when they’re young, with the goal of creating lifelong healthy lifestyles.

Cornell Cooperative Extension sponsors a summer gardening program called Roots and Wisdom that teaches children to grow vegetables and prepare them for meals. The YWCA on Washington Avenue teaches children and families about fresh fruits and vegetables through a Farm to Preschool market. Schenectady County Public Health Services found that just by putting fruit baskets at eye level in school cafeterias meant kids were more likely to incorporate fruit into their daily lunches.

Familiarity with healthy food is a big piece of the puzzle, but it’s certainly not the complete picture. If the nation wants to end its obesity epidemic among the poor, the Rev. Phil Grigsby believes it should look first at ending poverty.

The leader of the Schenectady Inner City Ministry — an organization that runs the largest emergency food pantry in the county and sponsors a free lunch program for kids — has noticed perception and exhaustion play just as large a role in obesity as unfamiliarity with healthy foods.

“When you’re in poverty, the tradeoffs you make in your daily routine are very demanding and very exhausting,” Grigsby said. “People who are not walking in those shoes come in and say, ‘Well, if we just put this great food store here everyone will flock to it.’ The challenge, too, is if you work two jobs, get on the bus at 6 in the morning to take the kids to day care, work a full day, get home late, do you have the energy to think about cooking a healthy meal?”

Efforts to convince people that eating healthy doesn’t have to be so hard or time-consuming may not do much either, Grigsby says, at least not in the short term. For so long, the national consensus has been that fast food is easy, junk food is cheap and healthy food is fussy and expensive. It doesn’t matter if this is not always the case.

“Perception is reality,” he said. “If a person or community perceives it, it’s true to them. People need to perceive that these foods are affordable. We see 100 families a day four days a week. If Cornell Cooperative Extension comes in and says we’ll offer a free training course on how to utilize these healthy foods we’re lucky if we get 20 people. Partly it’s because it’s just out of their worldview. Partly they think it’s just too good to be true, that anyone cares how they eat. Partly they’re just surviving day by day and can’t see that far into the future.”

It could be why, week after week, Abdul Hussain has to throw out lemons that have gone brown, peppers that have shriveled and lettuce that has wilted behind the glass counter of his convenience store. He manages the Unity Market on Van Vranken Avenue in Schenectady — one of three convenience stores in the city participating in Capital District Community Gardens’ Healthy Convenience Store Initiative, which provides them with the produce at a cheaper price than they could get it elsewhere and refrigeration units to store it in. The other two stores are in the city’s Hamilton Hill neighborhood that are abuzz with activity in the afterschool hours of the day as people buy cigarettes, beer, candy, chips and soda.

The goal of the initiative is to give people more options when they need food in a pinch and their neighborhood convenience store is the easiest place to get it. It’s a worthy cause, given that four out of 10 Schenectady residents surveyed last year by the Schenectady Coalition for a Healthy Community reported running out of food at least once a year. In the city’s Hamilton Hill, Eastern Avenue and Central State Street neighborhoods, that number grows to more than half of residents. Many of these same people were also obese, diabetic or both.

“They just don’t buy it,” Hussain said of the produce from Community Gardens. “They come in here, they look around, they buy the chips and candy. I put the candy in the glass case next to the vegetables because that’s what they buy.”

Hussain acknowledged that his store will always be more popular as a place to grab a quick snack, but said a good number of people come in to buy groceries, too — usually cereal, breads and canned goods.

The convenience store initiative was never meant to be the “magic bullet” solution to the city’s food desert problem, said Amy Klein, executive director of Capital District Community Gardens. It has enough success in the city and in Albany and Troy to make it worthwhile to continue, she said.

“The fact is that we, as a society, have very poor eating habits that have been developed over a long period of time and it’s not going to be solved by one solution and it’s not going to be solved quickly,” she said. “So is this the solution? No. But it is part of the solution. People are very open to exploring different fruits and vegetables once they are given the opportunity, but they deserve the opportunity.”