5. Increasing access to healthy foods in Pennsylvania



An initiative to increase the number of supermarkets in deprived communities boosted local employment and business, but poor monitoring made it hard to measure impacts on the dietary health of the local population.





The Food Trust is founded as a non-profit organisation (NGO) focused on increasing fresh food knowledge and access.


Closure of the supermarket and other stores in Progress Plaza, North Philadelphia – the oldest African-American-owned shopping centre.


The Food Trust begins research into poor supermarket access and its impact on health.


The Food Trust publishes the research report Food for every child.


Philadelphia City Council holds hearings on the issue of supermarket access.


The Food Trust convenes the Food Marketing Task Force.


The Pennsylvania Fresh Food Financing Initiative (PFFFI) is launched.


The PFFFI is recognised as one of ‘the top 15 innovations in American government’.


A new fresh food supermarket opens in Progress Plaza – the neighbourhood’s first in 10 years.


The PFFFI’s funding is fully exhausted and outreach to new projects ceases.


The Obama administration launches the Healthy Food Financing Initiative (HFFI) to promote access to healthy food and address obesity.


The Food Trust publishes a five-step framework for increasing access to fresh, healthy food, using the PFFFI as an example.


In 2018, Pennsylvania had a population of around 13 million and was the ninth most densely populated US state. While the population’s average income is slightly above the US average, in 2018 around 13% of people were living in poverty and one in three over-16s was unemployed.

The state has high levels of diet-related poor health. Obesity is rising and in 2017 around a third of Pennsylvania’s adults were obese. In 2016, only 15% of adults were eating five or more servings of fruit or vegetables a day, and a significant proportion of people were inactive, with 28% of adults reporting no physical activity in the past month in 2017.

Philadelphia is the largest city in Pennsylvania. Since the 1960s, complex social, economic and public policy factors had left many neighbourhoods without supermarkets or other businesses, known as the ‘grocery gap’. This gap was underpinned by a range of factors, including an exodus of white, middle-class families to homes in the suburbs and a loss of businesses as a result of more business-friendly zoning in other areas.

Philadelphia’s supermarket shortage reduced access to healthy, fresh food and increased health inequalities for those left behind. One example was Progress Plaza, Philadelphia’s oldest African-American-owned neighbourhood development, which served as a vital part of the African-American community for three decades. When the Plaza’s supermarket closed in 1998, the Plaza fell into disrepair, access to healthy foods declined and diet-related conditions such as obesity increased.

The intervention

The Food Trust is a Philadelphia-based NGO that aims to increase access to healthy foods such as fruit and vegetables in underserved neighbourhoods. In 2001, the organisation published a report entitled Food for every child: the need for more supermarkets in Philadelphia, exposing the lack of access to healthy food in Philadelphia and its negative health impacts. The report included maps that starkly revealed neighbourhoods affected by multiple adverse factors, including no or few supermarkets, low incomes and high rates of diet-related deaths. This graphic illustration of the problem communicated powerfully to policymakers that food access was an urgent and expensive public health concern as well as an economic and social justice issue.

Philadelphia City Council welcomed the report and asked The Food Trust to convene a taskforce to develop ways of increasing supermarkets in underserved areas across Pennsylvania, with the goal of increasing access to healthy food and improving diet-related health. The taskforce brought together stakeholders from the public sector, businesses and civil society to discuss the action needed, and published 10 recommendations in a report in 2004.

In response to these recommendations, later that year the state governor launched the Pennsylvania Fresh Food Financing Initiative (PFFFI) to attract supermarkets and grocery stores to underserved urban and rural communities. The PFFFI’s objectives were to:

  • reduce the high incidence of diet-related diseases by providing healthy food
  • stimulate investment of private capital in low-income communities
  • remove financial and other barriers for supermarkets to operate in deprived communities
  • create living wage jobs
  • prepare and retain a qualified workforce.

The PFFFI was a state-wide financing programme, operated as a public-private partnership between Pennsylvania’s state government, The Food Trust, a community development funder called the Reinvestment Fund, and the Urban Affairs Coalition, an organisation that works with local communities to drive change.

Each organisation played a unique role in implementing the programme. The Food Trust and the Reinvestment Fund promoted the initiative across the state and identified potential markets, assessing where the need was greatest and how the PFFFI’s resources could best be used. The Pennsylvania government provided US$30m in seed funding over the first three years and the Reinvestment Fund raised a further US$117m from banks and philanthropic foundations. The Reinvestment Fund used the funds to offer grants and loans to supermarket operators locating in underserved communities. The Urban Affairs Coalition worked with supermarket developers to increase opportunities for local people to be involved with the construction, operation and ownership of funded stores.

Funding for the PFFFI ceased in 2009 following the economic crisis. However, there was ongoing support for the initiative at state and federal levels, and the state’s House Appropriations Committee recommended the programme be revisited when the economic climate improved.


No formal evaluation process was built into the design of the PFFFI but several small studies were undertaken to assess different impacts of the programme across different parts of Pennsylvania.

Between 2004 and 2010 the programme achieved several positive outcomes – for example:

  • More than 5,000 jobs were created or retained, and revenues of neighbourhood stores in deprived communities increased. The Reinvestment Fund estimated that every US$1 invested generated US$1.5 in benefits to the community.
  • More than 400,000 residents gained greater access to healthy food.
  • The initiative inspired similar projects in New York, New Jersey, Illinois, Louisiana and Colorado, as well as a national programme, launched in 2010, to improve access to healthy food through providing grants and loans, using joint funds from the departments of agriculture, treasury, health and human resources.
  • The programme dispelled negative myths about deprived communities, including that businesses could not be profitable and crime would be higher in deprived communities.

No studies identified any impact on diet-related or health outcomes. One study found that proximity to a supermarket was not related to weight or dietary quality among residents from urban food desert neighbourhoods. Another reported no significant impact on body mass index (BMI) or daily fruit and vegetable consumption after six months of a new supermarket opening, although the follow-up period may have been too short to detect changes.

Lessons learned

What worked well

  • The Food Trust provided powerful institutional leadership, partly owing to its strong links to the community in Philadelphia, which gave it credibility.
  • The Food Trust’s high-profile report Food for every child provided high quality evidence of the problem and helped create a policy window for change.
  • Elected State Representative Dwight Evans used his influential position to champion the issue across the state and secure support for action. High levels of public support further increased political engagement.
  • Bringing together diverse stakeholders from the health, development and economic sectors facilitated shared understanding of the issues and built consensus on the solutions.
  • The initiative maintained its focus on the single issue of the grocery gap, which prevented the message from being diluted.
  • The programme’s flexible design, combining financial grants and loans, enabled support to be tailored to the different actors and contexts and helped the programme strike an appropriate balance between risks and responsibilities.

What worked less well

  • There was no formal, comprehensive evaluation built into the PFFFI. This substantially limited the quality of subsequent attempts to measure its impacts. For example, because no baseline data about diet or BMI were collected, it was difficult to fully assess the programme’s success.
  • Follow-up studies found no evidence that the PFFFI increased healthy food consumption or improved diet-related health problems. This could be due to the short timescales of most studies, the challenges of studying the complex causes of obesity and complex impacts of the intervention, or a lack of accurate data. Meanwhile, some evaluations measured only interim economic indicators, such as numbers of new supermarkets or jobs created, which gave no information about health impacts. This absence of evidence could deter policymakers from improving food access to tackle health problems in the future.
  • Despite the wide variety of private partners involved in the PFFFI, funding ceased in 2009 once the state could no longer provide financial support following the financial crisis. This raises questions about the long-term sustainability of public-private partnerships.

Implications for the UK

The UK faces similar challenges, including food deserts in deprived neighbourhoods and the decline of the high street, characterised by shop closures and local job losses. This case study provides some important lessons on how different actors from public health, development and economic sectors can come together to develop joint solutions to these problems.

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