Healthy Retail SF

BUILDING HEALTHY CORNER STORES & HEALTHY COMMUNITIES

Healthy Retail SF Report: 2016 Prepared by: Office of Economic and Workforce Development (OEWD) and Department of Public Health HEALTHYRETAILSF: A CITY-COMMUNITY PARTNERSHIP

WHOLE GRAINS HealthyRetailSF.org VITAMINS HealthyRetailSF.org MINERALS HealthyRetailSF.org “Whole ” ingredients provide good energy, Fruits and vegetables provide Vitamin C, Fruits, vegetables, whole grains, protein, digestion, and blood sugar levels. Beta-carotene, Lutein, Fiber, Antioxidants. dairy & beans provide energy & immunity. for healthy weight for shiny skin, hair & eyes healthy teeth, bones, weight

2 TABLE OF CONTENTS

5 BACKGROUND

6 A LITTLE BIT ABOUT US

8 GOALS & OBJECTIVES

10 CONVERTED STORES

12-21 ACCOMPLISHMENTS: 2014-2016

22 HEALTHYRETAILSF LOOKING FORWARD

IRON HealthyRetailSF.org WATER HealthyRetailSF.org 100% JUICE HealthyRetailSF.org Whole grains, animal protein, beans & leafy Our bodies are 70% water. Hydration “100% Juice” beverages provide Vitamin C. greens strengthen energy & learning ability. regulates temperature and removes waste. for good skin & rosy cheeks for smooth skin for healthy gums

3 BEFORE AFTER

Before and After Images of Daldas Grocery, a HealthyRetailSF Participant BACKGROUND

HEALTHY RETAIL SAN FRANCISCO: SUMMARY

HealthyRetailSF is an incentive-based, voluntary pilot program for merchants of local retail shops, also known as corner stores, to help shift business models and make the changes needed to remain competitive but to also provide healthier food options in their communities. HealthyRetailSF program was established by legislation to promote healthy eating and make fresh produce and healthy food products available to existing residents in communities where there is a lack of healthy food options. It combines a community engagement approach along with store redesign, and technical assistance, bringing together facets of business, government, and community to make transformations a reality. The goals of the program are to promote healthy eating, strengthen small independent business and increase community cohesion while reducing visibility and de-normalizing unhealthy products so that all residents and children have access to healthy, fresh and affordable foods.

Small independent retailers serve a critical role in community health, but many times lack the tools and support to stock healthy foods. In an effort to support these merchants, the HealthyRetailSF pilot program built upon existing grassroots efforts, HealthyRetailSF is led and deployed by the Office of Economic and Workforce Development (OEWD) in partnership with the San Francisco Department of Public Health (SFDPH), Healthy Southeast (Bayview HEAL Zone), and the Tenderloin Healthy Corner Store Coalition (TLHCSC), the Small Business Development Center (SBDC), and Sutti Associates.

Stores in the Bayview Hunters Point (BVHP), Tenderloin (TL), and the Ocean View, Merced Heights, Ingleside (OMI) neighborhoods are participating in HealthyRetailSF, where they were able to have access to resources and support that allows them to redesign the physical footprint of the store space, reconfigure shelving for more healthy products, make improvements to exterior signage and facades, install new equipment and appliances; and obtain technical assistance including updating business operation plans, marketing, and education, in addition to community market research and promotions. Since the inception of HealthyRetailSF in 2013, results are showing that the store transformations are working:

`` Increased total sales by an average of 25% per store `` Increased total sales by an average of $5,000+ per store per month `` On average each store is selling over 1,615 units of produce more per month `` Over 11,000 more units of produce are being accessed in communities per month `` Increased selling display space for fruits, vegetables, healthy produce while display space for liquor, tobacco and other unhealthy food products decreased

5 A LITTLE BIT ABOUT US

HISTORY

Many studies have demonstrated that the health (Bayview HEAL Zone), formerly Heal Zone/Southeast inequities and disproportional impacts that low- Food Access (SEFA), and the Tenderloin Healthy income and communities of color suffer are due in Corner Store Coalition (TLHCSC) piloted the initial large part to diet-related illnesses such as diabetes, corner store conversions with Sutti Associates and hypertension, and heart failure.123 This situation publicized “healthy standards assessments” of is related to the availability of unhealthy food and over 70 corner stores in annual shopping guides to drink options, as well as alcohol and tobacco in help introduce healthy food products and reduce areas where very little or no affordable healthy and unhealthy influences in these neighborhoods. fresh food options exist. These areas are commonly They raised awareness of the corner stores offering known as “food swamps.” Conversely, regular fruit healthy products and held a variety of community and vegetable consumption is linked to reduced events to promote the healthy changes to risk for heart disease and some cancers.4 In two neighborhood residents. of San Francisco’s food swamps, the Tenderloin In the fall of 2013, prompted by resident food and Bayview Hunters Point (BVHP), deep health leaders (Food Guardians in the Bayview Hunters and social inequities and the chronic stressors Point and Food Justice Leaders in the Tenderloin), associated with life in poor neighborhoods, are City leaders and agencies came together to launch key contributors to the poor health of residents, a new city and community partnership to increase who have some of the city’s highest rates of heart incentives for small business to offer affordable and disease, cancer and premature death.5 healthy food products and combat food swamps. In 2010, the San Francisco Department of Public Legislation introduced by Supervisor Eric Mar Health (SFDPH) partnered with grassroots groups and co-sponsored by Supervisor Jane Kim and to address limited food access in the Tenderloin Supervisor Malia Cohen created the Healthy Retail and BVHP neighborhoods. Healthy Southeast San Francisco (HealthyRetailSF) pilot program. 6 HealthyRetailSF is led and deployed by the Office of Economic and Workforce Development (OEWD) in partnership with San Francisco Department of Public Health (SFDPH), the two coalitions, Bayview HEAL Zone and the TLHCSC, with expert technical Healthy Food Retailer:* assistance from Sutti Associates and the Small noun Business Development Center. A retailer who devotes at least 35 The establishment of HealthyRetailSF provided a percent of its selling area (shelf and definition of a healthy retailer; created an expert floor) to fresh produce, whole grains, advisory group; allowed for the design of program structures and tools to incentivize small businesses lean proteins, and low-fat dairy to offer healthy products; and strengthened products; devotes no more than 20 neighborhood wide grassroots outreach and percent of its selling area to tobacco partnerships with store owners for healthy retail and alcohol products, and; satisfies makeovers. Healthy retail efforts support small the minimum wage requirements for independent businesses, protect the fabric of employees set. neighborhoods, strengthen the community, reduce unhealthy influences and increase access to healthy *defined by legislation affordable products. HealthyRetailSF promotes economic development, community development and improved public health. 1,2,3,4, & 5 Citation on page 23

7 GOALS & OBJECTIVES

HealthyRetailSF builds upon the best practices of previous efforts and provides interested small business owners with the tools and resources they need, along with focused attention from experts, to develop a business model that allows them to introduce and integrate healthy food options. The program’s ultimate goals are to increase access to healthy food, engage local residents in decision making processes, reduce unhealthy influences, strengthen communities, and stimulate economic development and job creation.

OBJECTIVES `` Redesign and transform corner stores as healthy-food retailers

`` Improve the availability of healthy foods in corner stores

`` Increase the amount of store revenue from healthy-product sales

`` Reduce the amount of shelf space dedicated to selling tobacco and alcohol

`` Engage and empower communities in the transformation of retail environments

8 FRAMEWORK HealthyRetailSF operates a comprehensive and unique model to assist corner stores by focusing on three areas:

`` Community Engagement: This area of focus, provides assistance with `` Market research & community surveys community engagement and community marketing that is coordinated `` Branding, shelf talkers, signs, etc. and sustained by trained resident food leaders and community coalition `` Assist with store redesign & launch members and coordinators, who conduct customer surveys, assist `` Monitor adherence to standards with store reset days, visit monthly to provide produce feedback and `` Report card & ongoing Technical conduct store launches and media events-- all with the goal to increase Assistance `` Promotional events and activities the stores visibility and for the community participation with their local `` Taste testing & cooking demos retailers. `` Health promotion in/out store `` Marketing materials

`` Redesign & Physical Environment: This area focuses on the physical `` Store design and layout needs of the store to allow for the introduction of healthy food products `` Schematics and product placement `` Inventory and merchandising needs and equipment. The store’s physical environment with an efficient `` Equipment store layout, upgraded or new equipment like produce bins, shelving, `` Facade Improvements produce refrigeration equipment, and building façade, such as signage `` Signage: pricing & shelf talkers and awning, allows for an inviting retail space for healthy foods. `` Americans with Disabilities (ADA) `` Arts and Murals

`` Business Operations: This area focuses on the capacity of the `` Business Model/Plan Development business owner to improve and transition into the new business model. `` Produce distribution & Maintenance `` Sourcing of healthy products Assessments are conducted to understand needs and tools that are `` Tax and Debt Planning then provided with one-on-one guidance, such as securing a lease, `` Credit Building develop debt management plan, access to capital, Point of Sale (POS) `` Access to capital system training, merchandising and produce handling, and other `` Lease assistance customized workshop referrals to support the business owner in their `` Point of Sale (POS) Systems transition to a healthy retailer.

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A Program to Redesign Corner Stores and Improve the Health of the Community: • Increase Sales & Sales Tax Revenue • Improve Sustainability of the Business • Increase Healthy Food Products • Decrease Unhealthy Influences • Increase Community, Customer & Merchant Satisfaction 1 MERCHANT OUTREACH

We collaborate with your community to build awareness of HRSF’s offer to help corner 2 ASSESSMENT store owners improve products and thereby, To understand the needs of a participating the health of customers. business, we conduct an assessment of operations, merchandising, finances, healthy and unhealthy product offerings, other relevant practices and customer preferences. 3 PLAN An Individual Development Plan (IDP) is written to help the business transition into becoming a healthy food retailer. It outlines steps to redesign and create more sales space, order and install equipment, engage An agreement is signed with the business the local community to raise awareness of owner and store upgrades begin. Imple- the business and implement a sustainable mentation will vary between businesses, business model; plus a budget and schedule. based on current operations and offerings. The interventions can range from technical assistance, attending workshops, and marketing to major store redesign, new equipment, and facade and tenant improvements. 4 IMPLEMENTATION

5 EVALUATION

Consultant(s) will be assigned to guide and assist IDP implementation, troubleshoot when needed and monitor business per- $ formance. While minimally, quarterly visits will be scheduled, the level of interaction between consultant(s) and store owner will depend on the findings and the IDP.

11 ACCOMPLISHMENTS: 2014-2016

ESTABLISHED HEALTHY RETAIL ESTABLISHED PROGRAM ESTABLISHED A CENTRALIZED SF ADVISORY COMMITTEE INFRASTRUCTURE AND EXPERT RESOURCE CENTER: STAFF WWW.HEALTHYRETAILSF.ORG

CONVERTED NINE STORES ENGAGED COMMUNITY RESIDENT FOOD LEADER/ AND PROVIDED TECHNICAL MEMBERS IN NUTRITION WORKFORCE DEVELOPMENT ASSISTANCE EDUCATION AND HEALTHY RETAIL EFFORTS

12 STRENGTHENED HEALTHY SHARED HEALTHYRETAILSF RAISED AWARENESS ABOUT RETAILER SKILLS AND BEST PRACTICES HEALTHY RETAIL EFFORTS COLLABORATION

DEVELOPED LOCAL INCREASED TOTAL SALES AND PARTNERSHIPS PRODUCE AVAILABILITY

13 ACCOMPLISHMENTS: 2014-2016

ESTABLISHED HEALTHY RETAIL SF ADVISORY HealthyRetailSF Advisory Committee COMMITTEE ``Christina Goette, Director, Shape Up San Francisco ``Michael Janis, Manager, SF Wholesale Produce Market

The HealthyRetailSF Advisory Committee is a ``Miriam Zouzounis, Arab American Grocers Association; Small collaborative effort that provides guidance and direction Business Commission for the program, helps develop strategic goals and serves ``Hannah Burton Laurison, Healthy Retail Expert as a resource to program staff and consultants. The ``Merry Minkler, UC Berkeley, School of Public Health HealthyRetailSF Advisory Committee is composed of ``Leo O’Farrell, San Francisco Human Services Agency representatives from community partners such as Shape ``Nick Pagoulatos, Aide to Supervisor Mar Up San Francisco, Bayview HEAL Zone, the Tenderloin ``Diane Sokolove, San Francisco Planning Department Healthy Corner Store Coalition, the Arab American ``Pedro Vidal Torres, National Council on Alcoholism and other Drug Addictions, Bay Area Grocers Association, the Youth Leadership Institute, the Experts: San Francisco Wholesale Produce Market, the Planning Gabriela Sapp, Small Business Development Center Larry Brucia, President, Sutti Associates Department, the Department of Public Health, and the Jessica Estrada, Department of Public Health

Human Services Agency and other industry experts. Staff: Jorge Rivas, Office of Economic and Workforce Development Susana Hennessey Lavery, Community Health Equity & Promotion Branch, SFDPH

ESTABLISHED PROGRAM INFRASTRUCTURE AND EXPERT STAFF

HealthyRetailSF is a partnership between the Office of Economic and Workforce Development (OEWD) and the San Francisco Department of Public Health (SFDPH) in coordination with community based organizations and consultants. A team of trained Resident Food Leaders and coordinators from Bayview HEAL Zone and the Tenderloin Healthy Corner Store coalitions, along with store redesign, business operations and community engagement experts provide in-depth assistance to retailers who wish to sell a broader selection of healthy products and work towards becoming a Healthy Food Retailer.

14 ESTABLISHED A CENTRALIZED RESOURCE CENTER: WWW.HEALTHYRETAILSF.ORG

A web based Centralized Resource Center highlights a wide range of city and partner resources available to small businesses wishing to increase their healthy food offerings. Information such as sourcing healthy food products; access to capital, tips on merchandising and maintaining healthy and fresh foods; and keeping the store up to code are available. HealthyRetailSF.org also provides information to practitioners and those interested in healthy food retailing programs, in addition to updates on participating corner stores and the ongoing impacts of HealthyRetailSF.

CONVERTED NINE STORES AND PROVIDED TECHNICAL ASSISTANCE

Since 2014, the program completed the conversion and transformation of nine local neighborhood stores. The HealthyRetailSF partnership has conducted store conversions in the Bayview Hunters Point, Tenderloin and Ocean View, Merced Heights, Ingleside neighborhoods and integrated the two previous pilot conversions. HealthyRetailSF implements a comprehensive five-step model for transforming corner stores into healthy food retailers. Between of $15,000 to $20,000 in equipment and in-kind consulting services were invested per store, in addition to grant funding secured by the community.

The HealthyRetailSF team 1) conducts grassroots multilingual outreach to retailers. Based on interest, the team then 2) assesses the physical, operations, and engagement level of stores using a point system to select the stores to participate in the program. The team 3) develops a detailed Individualized Development Plan (IDP) for each store, outlining a series of recommendations and steps for becoming a sustainable healthy food retailer, then 4) the IDP is then implemented, with support of HealthyRetailSF consultants that provide customized technical assistance for a period of three years. Finally, 5) data is collected to evaluate impact. Tools and protocols have been developed specific to the implementation of each step. In addition, to the nine stores converted, an additional 5 stores in San Francisco have received technical assistance from HealthyRetailSF consultants, including participation in a SFDPH pilot to link permit suspensions to concrete healthy changes in stores. 15 ACCOMPLISHMENTS: 2014-2016

ENGAGED COMMUNITY MEMBERS IN NUTRITION EDUCATION AND HEALTHY RETAIL EFFORTS

The HealthyRetailSF team prioritized community leadership through Resident Food Leaders from community partners such as Tenderloin Healthy Corner Store Coalition and Bayview HEAL Zone that conducted customer surveys, assessments, taste testing, healthy retail tours, community and media events, played a crucial role in the store reset, and conducted community outreach for converted stores. The conclusion from the surveys and feedback was that community members wanted more access to healthy foods in many local stores. In the Tenderloin alone, over 4,000 community members, or nearly 10% of the neighborhood, participated. Additionally, the coalitions conducted yearly community events to celebrate achievements, solicit input on coalition activities and raise awareness and distribute Healthy Retail Shopping Guides and recipes.

RESIDENT FOOD LEADER/ WORKFORCE DEVELOPMENT

Bayview HEAL Zone and the TLHCSC community engagement coordinators recruited and trained over eight Resident Food Leaders in the Tenderloin and five in the Bayview Hunters Point to work within the communities and at local stores to conduct outreach, provide testimony and provide education on nutritional benefits, train retailer on how to maximize the merchandising of healthy produce and their maintenance so they last longer, and information on how the food system and food justice works. Countless ongoing hours continue to be dedicated to “on the job” skill development and practices.

16 STRENGTHENED HEALTHY RETAILER SKILLS AND COLLABORATION

In 2015, program staff, consultants, and coalitions held the first convening of healthy retail merchants. The convening of HealthyRetailSF business owners was an effort to evaluate and gather program feedback to improve on service provision and identify any gaps with the program’s implementation. The convening also served as a venue for the business owners to share their experience and challenges in transitioning their business model.

SHARED HEALTHYRETAILSF BEST PRACTICES

HealthyRetailSF hosted the first San Francisco Bay Area Healthy Retail Convening of healthy retail practitioners, wholesalers, urban-agriculture advocates, and others which was organized by the San Francisco Department of Public Health 75 and SPUR. With support from the San Francisco Foundation, HEALTHY-RETAIL this all-day regional convening gathered over 75 healthy-retail representatives from nonprofits, county health departments, REPRESENTATIVES and private entities from Sonoma, San Jose, Watsonville, from nonprofits, county health Solano, Oakland, Berkeley, Marin, Santa Clara, San Mateo, and departments, and private entities other California cities. Participants shared their successes and challenges in implementing a healthy-retail program, including planning for community engagement; business support and development; sourcing and distribution; building connections with urban agriculture; marketing; and evaluation. Lessons learned from HealthyRetailSF and from other similar programs helped inform a shared agenda for improving the retail environment in low-income communities in and around the Bay Area and in California. In addition, HealthyRetailSF staff and consultants have presented at international, national, state and local conferences, participated in webinars and provided technical assistance (TA) and training to numerous groups including programs in the City of Edmonton, in Alberta, Canada, who were interested in learning more about San Francisco’s Healthy Retail Initiative.

17 ACCOMPLISHMENTS: 2014-2016

RAISED AWARENESS ABOUT HEALTHY RETAIL EFFORTS

Over 14 press events have showcased healthy retail efforts, local community, healthy food leaders, and other community leaders resulting in local, statewide and national print, TV, radio, electronic newsletters and social media coverage. Over 17 media outlets have covered healthy retail efforts in the Tenderloin alone. Highlights of media coverage include: CNN, the Chronicle, SF Public Press, Next City, KTVU Radio, Hoodline, KALW, the SF Examiner, and Central City Extra. HealthyRetailSF has garnered interest from national, state, regional and local news outlets because of its innovation to help retail stores transform into stores that provide healthier food options for the community.

DEVELOPED LOCAL PARTNERSHIPS

HealthyRetailSF have many partners. One of the partners is the EatSF Produce Voucher Program. Vouchers for produce that are redeemed at HealthyRetailSF participating stores and others represented almost 6,000 vouchers at $5 each or $28k of produce purchased by community. Other partner $28,000 programs include: Cooking Matters, 18 Reasons, and integration of HealthyRetailSF OF PRODUCE PURCHASED criteria into Planning Department and from almost 6,000 EatSF Produce vouchers Environmental Health procedures.

18 INCREASED TOTAL SALES AND PRODUCE AVAILABILITY PRODUCE SOLD

Evaluation is critical to the sustainability of AT 3 ProduceSTORES Sold - INNew 2015Stores HealthyRetailSF. Evaluation measures review the potential 300% direct impacts of the program including: increased % Change in Produce Sold Per Month Store A 266% offerings of healthy foods items; increased sales/sales 250% tax revenue; improved sustainability of the business; 200% 186% decreased promotion of alcohol and tobacco products and increased customer satisfaction. 150% 102% 100% With the implementation of HealthyRetailSF, store 81% Store B owners provide Point of Sale (POS)/cash register reports 50% 15% to monitor and evaluate their sales. Prior to the store 5% Store C 0% 0 1 2 3 4 5 6 7 makeover, an assessment of business is conducted to Months in program create baseline findings to understand the financial standing of the store, including data on sales and the amount of products sold. After the makeover, with support from HealthyRetailSF, the business owners purchase and install POS systems or cash register systems that allow for the collection of sales and units of product sold data. 1,500 units of produce sold Per Month at Data on the total sales and products sold is collected Store A confidentially and tracked by the business operations’ lead consultant. The data collected over a period of time is More produce sold after re-design used to understand and measure the economic success of at Stores B & C the business.

19 ACCOMPLISHMENTS: 2014-2016

INCREASED TOTAL SALES AND PRODUCE AVAILABILITY

In addition to POS/cash register information, HealthyRetailSF collects other data through various avenues including: `` Monthly report cards completed by Resident Food Leaders to measure the store’s ability to meet deliverables and to help identify further technical assistance; `` Customer surveys were conducted to track customer satisfaction and preference

`` Periodic overall assessments and evaluations of the stores

Through this methodology, the team was able to measure the results of the program:

`` Produce sales are increasing in all stores: With the shift in business model at each participating location, business owners experienced an increase in sales of produce. This statement may seem obvious, because after the makeover the businesses would sell the product, or increase the sale of a produce that they were not selling before. Actually, this is exactly the point, the product is selling. Just because the produce was introduced, it does not mean it will be in demand by the customer. The stores that did not offer any produce are actually selling the produce, which means there is demand. In addition, the stores that offered a limited quantity of produce before the transformation, also experienced an increase in produce sales. The increase in produce varied, for example in one store produce sells doubled, in another it had already tripled at the time the last evaluation was conducted.

`` On average, each HealthyRetailSF participating store increased their unit sales of produce by more than 1,615 units of produce each month, after just one year in the program. This means on average, over 11,000 more units of produce are being accessed in communities per month.

`` Total sales have increased by an average of 25%. The longer the store participates in the program, on average their total sales increase. The data showed in the first eight months of participation, there was a steady increase in total sales. This pattern, according to experts is normal. Sales will initially increase and level out over time, considering seasonality of produce and implementation of the new business model.

20 At Baseline Now Number Timeframe Store Number of produce of produce Since Store items/month items/month Re-Design

Store A 0 1,865 36 months

Store B 1498 5,550 15 months

Store C 0 1,616 8 months

Store D 16,874 17,641 5 months

Store E 362 656 7 months

`` A 5-10% increase in selling space for healthy product and produce and a 2-5% decrease for alcohol and tobacco products in stores. The goal for HealthyRetailSF is for these participants to reach Healthy Food Retailer status, where they dedicate less than 20% of their selling space to alcohol and tobacco products.

`` Unhealthy advertisements for tobacco, alcohol and sugary drinks were removed from outside of stores and inside near eye level of children and replaced with healthy nutrition information. In addition, coordinators promoted compliance with San Francisco’s Transparency Laws.

`` Leveraging public and private resources. Participating stores continue to make improvements using their own resources including adding and upgrading refrigeration units or shelving to increase impact of the public investment. In addition, businesses are taking advantage of other City programs such as the Human Services Agency’s “Jobs Now” program to hire locally and the Department of the Environment’s Small Business Energy Audits to help save and conserve on energy.

`` Increased awareness of Healthy Food Retailing among businesses. Neighborhood wide store assessments and shopping guides that were produced by coalitions showed that over 75 stores in the Bayview Hunters Point and Tenderloin neighborhoods are achieving higher “healthy retail” ratings due to their community engagement and outreach efforts and that a potential “ripple effect” is caused by store conversions. Between 2013 and 2015, the number of stores in the Tenderloin with a poor health rating (one or two stars) decreased from 43 to 25, while the number of stores with a good health rating (three or four stars) increased from 13 to 30.

`` Bayview-Hunters Point Healthy Shopping Guide: http://www.healthyretailsf.org/bayview-shopping-guide

`` Tenderloin Healthy Shopping Guide: http://www.healthyretailsf.org/tenderloin-shopping-guide 21 HEALTHYRETAILSF LOOKING FORWARD

HealthyRetailSF is supported by many city and community stakeholders, and the program is making a positive impact in low income communities. It is a small, but important program that strengthens businesses and creates healthier neighborhoods.

The HealthyRetailSF partnership is a comprehensive model that stands on the critical contribution of many community partners and experts. Community driven coalitions and Resident Food Leaders are essential to not only the store selection and reset process but also serve as an ongoing bridge between communities and small independent family run stores. HealthyRetailSF breaks down silos, work across city departments, create private and public partnerships and will continue to evolve and streamline systems that support health, community development and economic development objectives.

HealthyRetailSF has leveraged community and stakeholder support throughout San Francisco to transform corner stores into healthy-food retailers in food-swamp communities. Instead of relying on individual-level change, HealthyRetailSF will continue to change the policies, systems, and environments that impact community health through a growing public-private partnership.

For more information: • www.HealthyRetailSF.org • www.SoutheastFoodAccess.org • www.HealthyTL.org and www.facebook.com/healthyTL • http://sanfranciscotobaccofreeproject.org/case-studies/healthy-retail-san-francisco-2016/

22 CITATIONS:

1. Eleven percent of adults have diabetes. African-American adults are more likely to have diabetes, with a rate of 19 percent. Centers for Disease Control and Prevention, Division of Vital Statistics. “Deaths: Final Data for 2005.” 2008. Available at: www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf. [1] Centers for Disease Control and Prevention. “National Diabetes Fact Sheet, 2011.” Available at: www.cdc.gov/ diabetes/pubs/pdf/ndfs_2011.pdf.

2. Twenty-six percent of deaths in 2006 were due to heart disease. Heart disease is the leading cause of death for nearly all racial and ethnic groups. Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention. “Heart Disease Fact Sheet.” 2010. Available at: www.cdc.gov/dhdsp/ data_statistics/fact_sheets/fs_heart_disease.htm.

3. Low-income people and people of color are disproportionately obese. For example, 50 percent of African-American women and 45 percent of Mexican-American women are obese. [1] Ogden CL and Carroll MD. “Prevalence of Obesity Among Children and Adolescents: United States, Trends 1963–1965 Through 2007–2008.” Centers for Disease Control and Prevention, National Center for Health Statistics. 2010. Available at: www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.pdf.

4. Regular fruit and vegetable consumption is linked to reduced risk for heart disease and some cancers. Fruits and vegetables offer several important nutrients, like folate and magnesium, that Americans are deficient in. They also help with maintaining a healthy weight. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010, supra note 15, at 35–36.. Available at: http://health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf.

5. The Tenderloin is one of San Francisco’s poorest neighborhoods, with 35% of its 35,000 residents living below the federal poverty line, compared to a citywide average of 14% (city-data, 2011). With no full-service grocery store and its 70 corner stores primarily stocking pre-packaged food, sodas, tobacco and alcohol, lack of access to healthy food is a significant problem. The Tenderloin also has by far the highest tobacco and alcohol outlet density in the city (2011 ref; alcohol ref) and correspondingly elevated rates of tobacco use and alcoholism (REF). Together with deep health and social inequities and the chronic stressors associated with life in poor neighborhoods, these forces are key contributors to the poor health of residents, who have some of San Francisco’s highest rates of heart disease, cancer and premature death (SFDPH, 2012). Poor access to fresh produce results in health disparities in diet and diet-related health outcomes such as obesity, cardiovascular disease, and diabetes. A recent report documented that BVHP residents have an 8-14 year decreased life expectancy than their San Francisco neighbors (www.healthmattersinsf.org).

23 Office of Economic and Workforce Development San Francisco Department of Public Health 1 Dr. Carlton B. Goodlett Place 101 Grove Street City Hall, Room 448 San Francisco, CA 94102 San Francisco, CA 94102 sfdph.org oewd.org HealthyRetailSF.org (415)554-6969