If You Build It, Will They Come, and What Will They Eat? Investigating Supermarket Development in Food Deserts

Over the last decade, increasing attention has been paid to communities with low physical access to full-service supermarkets, commonly called food deserts. These often have disproportionately high rates of poverty and minority residents, raising additional issues for local officials and advocates. Widespread research has also documented associations between poor access to supermarkets and negative health outcomes. To address these issues, coalitions of stakeholders have used development incentives known as fresh food financing to bring new supermarkets into food deserts, often invoking associative health claims as motivation. To date, few health evaluations have been completed, though of published results, few show improved health resulting from new supermarket development. This dissertation uses a multi-level, mixed-methods approach to understand three primary research questions: 1) How different types of development processes yield different types of supermarkets, 2) How different types of new supermarkets may drive different patterns of shopper adoption, and 3) How consumers engage with new supermarkets, and how might these behaviors be meaningful for health? A variety of primary and secondary data sources inform this research: an extensive document review, analysis of redemption data from the Supplemental Nutrition Assistance Program, open-ended interviews with major fresh food financing stakeholders, and walking interviews and surveys with shoppers at a store developed with fresh food financing. The investigation finds that while a number of financing methods have been employed to improve access to supermarkets in food deserts, the highly professionalized tools promulgated by industry leaders and officials are most prevalent. Additionally, most projects include local development incentives, even those not specifically dedicated to expanding food access. Though the positive health effects of new supermarket development have not been empirically documented, this research shows that important diversity exists among the types of incentives and stores that have been created, which may also influence store adoption by low-income shoppers. Shoppers in this study grappled with changing their diets, even in the context of managing chronic disease conditions. These findings highlight important points of friction that must be addressed for new stores in food deserts to achieve desired health outcomes, and provide an illustrative model for those who hope to create greater synergy between community development and public health