H.L.I.T./Flickr

When an ailing Pittsburgh neighborhood got a supermarket after 30 years without one, people ate healthier—but for surprising reasons.

The day the Shop ‘n Save opened, Hill District resident Bobbie Street filled her cart. Cruising the supermarket’s gleaming aisles, the then-66-year-old told the Pittsburgh Gazette she was especially happy to be able to buy prepared chicken, plus all the other products she’d plucked from the shelves.

"It's good to be able to come right down the hill to get good stuff," she said. "It's a blessing."

The supermarket was, after all, the first the Pittsburgh neighborhood had seen in 30 years.

Once a jazz haven known as “Little Harlem,” the predominantly low-income, African-American Hill District had problems when it came to accessing nutritious food. As of 2013, half of the residents experienced food insecurity, more than three times the national rate. Locals traveled an average of 3.7 miles to shop for groceries. In a 2011 survey, 77 percent of a neighborhood sample were overweight or obese.

The Shop ‘n Save was supposed to bring change when it opened in 2013, after years of pushing by local food justice advocates. Now two years have passed. Did the supermarket make the neighborhood a healthier, better place to live—like Bobbie Street believed?

Yes, but not the way you might expect. Fresh fruits and vegetables did not magically materialize on everybody’s kitchen tables. But the supermarket may have shifted residents’ perceptions of their neighborhood enough to actually improve their diets.

How do we know? When plans for the Shop ‘n Save were first announced in 2011, Tamara Dubowitz, senior policy researcher at the RAND Corporation, jumped at the opportunity to measure its impact. Despite of millions of federal dollars aimed at eliminating food deserts and a White House campaign to promote healthy eating, little prior research had comprehensively captured the true effects of a new supermarket in a long-deprived neighborhood. Towards that end, Dubowitz and her colleagues initiated a longitudinal study of both Hill District and Homewood, another Pittsburgh neighborhood with similar sociodemographic characteristics but no new market.

(Flickr/opengridscheduler)

In both neighborhoods, two rounds of paid surveys were conducted in person, with more than 1,300 randomly-selected residents at baseline in 2011, and 831 at the follow-up in 2014. Both times, the researchers asked participants: What had they eaten in the last 24 hours? Where, how, and when did they shop for food, and how much did they spend? And how did they feel about access to food in their neighborhoods, and their neighborhoods in general?

The researchers used this information to calculate each respondent’s Healthy Eating Index score and daily intake of calories, fruits and vegetables, whole grains, fat, sugar, and alcohol. Analyzing the before-and-after responses, the researchers controlled for many sociodemographic variables, as well as other shopping-related circumstances that might affect how and what people ate.

Published this week in Health Affairs, the findings in some ways mirrored those of a few smaller, prior studies: Hill District residents did not buy any more fruits, vegetables, or whole grains after the Shop ‘n Save opened than they had before. In fact, in both the Hill District and Homewood, overall consumption of fruits, vegetables, and whole grains actually declined, for reasons Dubowitz says are unclear.

But there were also more nuanced, positive findings: In 2014, about a year after the Shop ‘n Save opened, residents consumed fewer calories overall, as well as less fat, alcohol, and added sugar. This was a significant difference compared to Homewood in 2014, where there were no significant changes in intake.

Fascinatingly, however, the differences between Homewood and the Hill District were not connected to where people shopped. Hill District residents who went to the Shop ‘n Save regularly did not decrease their sugar, fat, or alcohol intake any more than residents who kept shopping where they always had. Rather, the whole neighborhood improved together, as compared to Homewood.

“So that tells us there was something about the new store that changed these health behaviors,” says Dubowitz, “but it didn’t have to do with shopping.”

The change may have something to do with how people perceived their neighborhood. Before the Shop ‘n Save opened, about 67 percent of Hill District residents said they were satisfied, or very satisfied, with their neighborhood. One year after it opened, that rate rose to 81 percent.

Though she is still working on understanding how perceptions are connected to eating habits, Dubowitz believes it’s a pretty big deal that this relationship exists at all. “We know that neighborhood perceptions are important for overall community well-being and health,” she says. “We think that in and of itself is a large and important find for neighborhood investment in general.”

And the Shop ‘n Save was not a silver bullet in the Hill District, and nor are supermarkets for any neighborhood. Dietary habits are complicated, and changing one thing in one neighborhood isn’t enough to address major health issues, says Dubowitz. “Where you shop is not only based on where you live,” she says. “What you buy is not only based on where you live. And what you eat is definitely not only based on where you live.”

No study is perfect: A longer-lasting survey would probably reveal different results, and though the sample size was large, the study only looked at two neighborhoods. Also, there had been a long campaign for a supermarket in the Hill District before the Shop ‘n Save arrived. The results may not be generalizable to other places.

Still, the findings do support policies that seek to eliminate food deserts—or “food swamps,” if you prefer—through the introduction of better shopping options, says Dubowitz. But exactly why supermarkets help is more mysterious than it seems. Beyond quantifiable factors of access and calories, eating is tied to feelings, beliefs, place, and identity. To fight a national epidemic at the neighborhood level, it may be worth further investigating the emotional content of food.

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