HFFI is rooted in a comprehensive equity framework aimed at improving community health and economic revitalization in low-income, underserved areas. Specifically, HFFI works to create environments where healthy choices are easy and affordable and is a hallmark example of policy, systems and environmental (PSE) change.
Demonstrating the success of previous and on-going HFFI projects and statewide programs is a critical component of advocacy campaigns at the local, state and federal levels. Since the onset of the nation’s first healthy food financing program in Pennsylvania, efforts have been undertaken to measure outcomes— the effects on the target population— and impacts— the effectiveness of achieving program goals— within the context of both community health and local economics. Capturing these outcomes and impacts requires comprehensive evaluation plans that are aligned with the goals of local, state and federal HFFI programs, which are to:
- Engage the community to fix the market failure that leaves low-income communities without full service supermarkets
- Provide equitable access to healthy food
- Create jobs for community residents
- Leverage private investment in the community
- Improve community health in lower-income areas through perceptions of healthy food access, neighborhood satisfaction, dietary quality and long-term health outcomes
It is important to understand HFFI and improved healthy food access as PSE change, which involves an adjusted, longer timeline of intervention activities and effect. It also represents just one strategy in the greater efforts to create environments where all children can grow up at a healthy weight. The below graphic illustrates the sequence of evaluation for PSE change.
While some studies have emerged to challenge the impacts of improved healthy food access on body mass index (BMI), HFFI and PSE interventions are not a “silver bullet.” The consensus among many leading obesity prevention experts today is that multi-faceted approaches are required to reduce rates of childhood obesity, and while a supermarket alone may not singularly achieve the goal, healthy food retail is an important part of the calculus. As illustrated in The Food Trust’s Food Access Impact Pyramid (below), complementary strategies, including in-store marketing, healthy food incentive programs to increase affordability and nutrition education programs are needed to bridge the gap between improved accessibility to healthier foods and behavior change (29). A recent report by the McKinsey Global Institute found that a “systemic, sustained portfolio of initiatives, delivered at scale, is needed” to address obesity and the interventions themselves needed to “rely less on conscious choices by individuals and more on changes to the environment (30).”
As the complex relationship between food access and health continues to be better understood, current research continues to demonstrate the positive relationship between community health and access to healthy food (31) (32) (33) (34). Furthermore, HFFI policy and efforts to improve food access are rooted in more than 300 studies published between 1995 and 2013, which found that “living closer to healthy food retail is among the factors associated with better eating habits and decreased risk for obesity and diet-related diseases (35).”
Evaluation Case Study: The New Jersey Food Access Initiative
In 2014, The Food Trust launched a two-year comprehensive evaluation of the New Jersey Food Access Initiative (NJFAI), a statewide HFFI program implemented by Reinvestment Fund and supported by the Robert Wood Johnson Foundation, the New Jersey Economic Development Authority and Living Cities. The program has financed 22 projects with loans and grants totaling $25.2 million since August 2016.
In order to capture the breadth of health and economic impacts of the NJFAI, The Food Trust created the NJFAI Logic Model to inform program evaluation and serve as a model for the evaluation of other HFFI efforts. The logic model captures the goals of HFFI (outlined above) and the program’s expected outcomes, which are staged by short, medium and long-term impacts.
The evaluation strategy included customer surveys, focus groups and reporting on job creation:
- Customer demographics indicated NJFAI projects are serving the target population and surrounding area: 80% reported incomes less than $30,000, 85% were people of color and 80% reported having lived in the community for over 20 years;
- Surveys found that more that 97% of shoppers felt the new store improved their community;
- 70% agreed that the store encouraged them to buy healthier foods and/or beverages;
- Of those reporting trying new fruits and vegetables because of the store (37%), 70% reported buying more fruits and vegetables; and
- 1,712 local jobs were created or retained, not including 1,118 construction jobs.
Upcoming evaluation of the New Jersey program investments will include an economic impact analysis conducted by a third party evaluation team. Specifically, the analysis will capture the economic impacts of project construction and ongoing operations, as well as impacts on local property values.
Overall, the NJFAI has had positive impact and achieved short- and medium-term outcomes in underserved New Jersey communities:
- Jobs for community members
- Increased access to healthy food in the community
- Stores are a community gathering place and reach long-time residents
- Improvements in perceptions of the community, food access and neighborhood satisfaction
- Increased healthy food purchases — more fruits, vegetables and whole grains
Comprehensive and thoughtfully designed HFFI program evaluation — such as the NJFAI evaluation project — clearly illustrates the positive impacts and outcomes of HFFI on both community health and the local economy. While comprehensive evaluation plans require additional investment and resources, program administrators and partners, including CDFIs, state agencies and food access organizations, can capture and report positive program impacts.