REFRAMING “FOOD DESERTS”: THE HISTORY OF URBAN SUPERMARKET ACCESS AND ITS PUBLIC POLICY DISCOURSE by Karina Christiansen, MPP A dissertation submitted to Johns Hopkins University in conformity with the requirements for the degree of Doctor of Philosophy Baltimore, Maryland August, 2016 © 2016 Karina M. H. Christiansen All Rights Reserved ABSTRACT Background: Though supermarket access features prominently in the public health literature and may help explain diet-related health disparities in American cities, there is scant literature on the history of supermarket access or its prior public policy discourse. The dominant frame to understand unequal food access in American cities – the “food desert” concept – is based on a causal narrative of urban economic decline. However, the “food desert” narrative in its focus on economic status cannot account for the lack of quality supermarkets in black urban areas, independent of income. Objective: This dissertation research interrogated the assumption within the “food desert” frame that poor food access in low-income and racially segregated neighborhoods today is a product of economic decline. Rather unequal food access may be an on-going condition in low-income and racially segregated neighborhoods. As such, urban supermarket access is likely to have been contested in public policy prior to the current framing of the problem. Methods: This research used a parallel mixed methods design, incorporating complimentary empirical and interpretive methodologies. First, historical supermarket data from Brooklyn, New York were used to identify supermarket and neighborhood socio-demographic trends that occurred between 1970 and 2010 (Aim 1). Supermarket retail data were derived from Dun & Bradstreet and the Yellow Pages, and joined with neighborhood-level data from the U.S. Census. Second, a policy discourse analysis uncovered the prior public policy discourse on urban supermarket access, using documents generated by the supermarket industry, consumer advocates, and civil rights ! ""! groups between 1960 and 1999 (Aim 2). Documents were located from online databases (ProQuest History Vault, ProQuest Congressional, and ProQuest Central) and in the archives of a major supermarket lobby organization, the Food Marketing Institute. Results: The number of supermarkets declined in Brooklyn, New York between 1970 and 2010. Black and higher poverty areas had consistently higher ratios of person per supermarket than white and lower poverty areas. Between 1970 and 1990, white and lower poverty neighborhoods lost on average more stores than black and higher poverty neighborhoods; findings from the discourse analysis corroborate this description of which areas experienced supermarket closure. Supermarkets in predominantly black urban areas were consistently described as dirtier, more crowded, higher priced, and lower quality than stores in white areas; the lack of quality foods and higher prices in black neighborhoods was considered a problem of economic justice and posed a risk for hunger. Though the poor conditions of grocery shopping in black urban areas remained relatively stable over the study time period, the political discourse about urban grocery demonstrated a clear shift away from concerns about the problems of consumers in racially segregated and exploitative markets, towards concerns about the problems of businesses operating in poor urban areas. Accompanying the shifting problem frame was a diminished critique of the role of capital and racism in creating the marketplace for food in black urban neighborhoods; the supermarket industry, accused of profiteering from the spatially isolated poor in the 1960s and 1970s, repositioned itself in the 1980s and 1990s as an integral partner in urban economic redevelopment and health. Conclusions: The findings from this mixed methods research challenge the assumptions and the adequacy of the “food desert” frame in promoting equity in the marketplace for ! """! food. First, the “food desert” narrative claims that unequal conditions today are the product of supermarket migration, implying that prior to migration there was parity in supermarket access in the city. Yet both the empirical and discourse analysis provide evidence that urban supermarkets closed from white and more affluent neighborhoods; there is no evidence that black neighborhoods had either parity in access to supermarkets or in the quality of local supermarkets at any time during the study period. Second, the “food desert” decline narrative is used to promote supermarket reinvestment policies aimed at improving health and spurring urban economic development; such a policy ignores the role of racism in creating inequalities and therefore cannot address root causes of unequal food access. Neoliberal policies such as supermarket redevelopment try to improve well-being through expanded options in the marketplace. This study suggests the need to reframe urban food inequalities through the lens of racism, capital, and policy, and to rearticulate the role of government in protecting the rights of citizens rather than facilitating the choices of consumers. ! "#! Dissertation Readers: Keshia Pollack, PhD MPH (Advisor) Associate Professor, Department of Health Policy and Management Lainie Rutkow, PhD JD MPH Associate Professor, Department of Health Policy and Management Katherine Clegg Smith, PhD MA (Chair) Professor, Department of Health, Behavior, and Society Roni Neff, PhD ScM Assistant Professor, Department of Environmental Health Sciences Nathan Connolly, PhD MA Associate Professor, Department of History Holly Taylor, PhD MPH (Alternate) Associate Professor, Department of Health Policy and Management Caitlin Kennedy, PhD MPH (Alternate) Associate Professor, Departments of International Health and Health, Behavior and Society ! #! ACKNOWLEDGEMENTS You cannot survive a PhD program without the love and support of a community taking care of you along the way. I have been incomparably fortunate in mine. And thank goodness, because I have needed it. In the past five years I have experienced terrible loss, as well as uneven, often painful, but redemptive growth. To those who have walked with me, I thank you. I will always try to earn the support and love you have given so freely. First and foremost, I am indebted to the generosity of my funders. It has been an honor to be a Brown Scholar in Community Health; the incredible commitment of Eddie and Sylvia Brown gave to all of us both the opportunity and the responsibility to dedicate ourselves to creating healthy and just cities. Thank you to Dr. Robert Blum and my fellow scholars, particularly Aracelis and Stacy, for the help along the way. I am so grateful to have been included as a Center for a Livable Future-Lerner Fellow, and deeply thankful to the staff of the CLF, particularly Darlene and Becca, for their support and mentorship during a difficult time. I have learned so much from the CLF family, and I am proud to be a part of it. Thanks also to the Center for Qualitative Studies in Health and Medicine for a dissertation enhancement grant, and an opportunity to present my work to a great community of scholars. Many thanks go to my advisor Dr. Keshia Pollack; your support and trust allowed me to pursue a research topic and method that is unusual in our field, and your thoughtful guidance and standards of excellence helped push me to do my best. I appreciate your confidence in me and in the value of this work. Thank you for your patience and for your prayers through these years together. ! #"! I am deeply indebted to my thesis committee; thank you for your time, your warmth, and your belief in this research. To Lainie Rutkow, you have been an unfailing resource to me throughout this program, thank you for your open door and your sincere care. To Roni Neff, your thoughtfulness in approaching research has been a model for me to follow and was foundational in the development of this dissertation research. To Nathan Connolly, your belief in the potential of this work gave me permission to believe in myself. You knew what I was trying to do before I did - thank you for patiently guiding me towards the big questions that motivate this research and make it relevant. To Katherine Clegg Smith, you provide an intellectual home for students who are interested in the meaning of health and social conditions, not just their measurements. Thank you for helping me to see myself as a researcher and an academic - your encouragement has been instrumental in making me feel like I belong. To my mentor, Michael Hanchard, I owe particular gratitude. The research itself would not have been possible without your formative guidance; you opened the door to a new way of thinking about what is and what ought to be. More importantly, your sincere care for me as a whole person has helped me navigate the most difficult years of my personal and professional life. Thank you for believing in me, challenging me, and daring me to see myself as you see me. Special and heartfelt thanks go to Mary Sewell. You always opened your heart and your door to me, and were ready to greet me with a much needed hug. I am deeply grateful for you! In my time at Hopkins, I have had the privilege to know some of the most dedicated, brilliant, and humane women anywhere. I could not have made it through this ! #""! program without my HPM colleagues, nor would I have wanted to. Thank you Sarah, Julia, Paloma, Alene, and Shani for your friendship and care. To my Dissertation Support Group: Dorothy, Bess, Myra, Ramya, Waiwai, and Leslie, more than accountability, you provide community. To Kat, Jess, and Maria – I am forever thankful for the comfort, love, and support you have given me. Thanks also to Carrie, for years of friendship, statistics advice, and being my travel partner. I should know exceptional women when I see them – I somehow got to grow up with the most remarkable women I know. Thank you Kate, Leila, Jasmine, Brenda, Corinne, Dana, Becky, Julia, and Laura for loving me while we were learning how to be humans, for knowing me better than I know myself sometimes, and for being my family.