Working with Grocers to Support Healthy Eating

The Working with Grocers to Support Healthy Eating report, prepared for the Office of Nutrition Policy and Promotion, Health Canada, in collaboration with a working group of the Federal, Provincial, & Territorial Group on Nutrition, was released in June. The purpose of this report is to improve our understanding of how the food retail environment could promote and support healthy eating. The report explores: 1) actions underway in Canada and internationally, including concrete examples of current promising or innovative practices aimed at supporting healthy eating with a focus on grocers; 2) the current state of evidence, inclusive of gaps in evidence, to improve our understanding of how grocers could support healthy eating.

The introduction to the report states:

“There is global concern about rising rates of chronic diseases. Eating well, being physically active, and maintaining a healthy body weight can help reduce the risk of developing some chronic diseases. Social and physical environments influence food choice and the efforts of many sectors, including food retail, can help create supportive environments for healthy eating…

It is increasingly recognized that the availability, accessibility, and promotion of nutritious food in food retail environments may help to reduce the risk of obesity (as many food purchasing decisions take place in-store). This report looks at in-store interventions in Canada and elsewhere which seek to positively influence the purchasing of nutritious foods.

Shifts in the food retailing industry, consumer attitudes, and nutrition knowledge influence consumer purchasing practices and consumption trends. This report describes these influences and reviews the literature on interventions in the food retail environment to support healthy eating. Front-of-pack labeling programs, private labels, and restaurant initiatives were beyond the scope of this report.”

The Health Canada website comments that: “Measures of household food insecurity have been included on national health surveys since the mid-1990s, however, the use of different indicators and measurement inconsistencies have hindered the ability to track changes over time”.

To help address this, Health Canada commissioned a Discussion Paper on Household and Individual Food Insecurity in 2001 to explore issues related to the inclusion of indicators of food insecurity in a monitoring system.  This paper raised concerns that, ‘Household food insecurity has come to be recognized as a public health problem in Canada, but also as a serious social problem…Here the term, food insecurity, will be used to denote the limited, inadequate, or insecure access of individuals and households to sufficient, safe, nutritious, personally acceptable food both in quality and quantity to meet their dietary requirements for a healthy and productive life. The focus on limited, inadequate or insecure access to food due to financial resource constraints reflects the recognition that, while financial resources are only one of a range of factors that operate to determine individuals' food consumption patterns, they are the primary barrier to food access among low income groups. ‘

The Canadian Public Health Association (CPHA) notes that, “In recent years, attention to food security issues has been growing in Canada, with increasing concerns about economic access to adequate food for some sub-populations, the high cost of food in isolated communities, the recent rise in food prices globally, and concerns about the safety and sustainability of the food supply. The ability to access adequate food on a regular basis is a challenge for a significant number of Canadian households. In March 2009, over three quarters of a million people (794,738) used a food bank in Canada, an increase of 17.6%, or almost 120,000 people, compared to March 2008, representing the largest year-over-year increase since 1997. In 2004, more than 1.1 million house holds (9.2%) were food insecure at some point in the previous year as a result of financial challenges they faced in accessing adequate food.”

In this context, the ability to access good quality nutrition at reasonable cost is of primary concern to many households in Canada.

In the Working with Grocers report, in addition to details about their specific retail food initiative, key informants were asked about leadership, partnerships and collaboration, successes, challenges, and lessons learned.  7 common themes emerged from the interviews.

1. Support for promoting healthy eating in the retail environment:  There was unanimous support of the retail food environment being an important setting to promote and deliver healthy eating programs.  “Grocers reach a large portion of the population on a regular basis. Since purchasing decisions are often made in-store, point of purchase information programs have potential to positively modify consumer food choices.”
2. The success of partnerships:   Key informants felt that partnerships that included partners and collaborators like government officials or health professionals, such as a Registered Dietician, helped give programs credibility with consumers. Partnerships with university or government researchers helped to provide the necessary capacity for programs incorporating an evaluation component, especially with retailers augmenting the evaluations with store sales data.  Advisory committees helped ensure program content and implementation was mutually agreed and acceptable to all stakeholders.  Good communication and co-operative process were seen as key to success in working with community and other stakeholders.
3. The need for flexibility and simplicity:  Experience has demonstrated that successful programs are low cost and readily acceptable to store management and staff; adaptable and suitable for a variety of settings; simple and easy to implement; and build on the learning of existing successful projects.
4. The challenge of meaningful evaluation:  In order to build sustainable programs, impact measurement is invaluable.  It is often difficult for programs to access the skill, capacity and finance to provide effective internal evaluation; external support that provides clear outcome measurements, design evaluation tools and data collection methods would be of great benefit to improve the long-term success of programs.
5. Gaps in program supports:  Gaps identified in the development and implementation phases of programs where support is needed included:  “ready-made resources that retailers could distribute; retailer education and support for providing and promoting healthy eating messages; and in-store Registered Dietitians and Nutritionists.
6. Northern and remote communities - opportunities and challenges:  “The unique nature of retail in northern and remote areas led key informants to identify the need to answer the following questions:  1) What can be done to support retail access to country and traditional foods?  2) What is the best strategy, duration and impact for northern or remote retail-based interventions? 3) How does culture influence First Nations and Inuit purchasing and consumption decisions? 4) How to best cultivate retail community partnerships and develop collaborative programs, especially with Aboriginal communities?”
7. Grocers’ ideas on what they can do to support healthy eating:  “Retailers provided a number of suggestions for healthy eating initiatives both in-store or within the school or community environments:

• Develop industry-wide campaigns focusing on one message but using multiple intervention strategies.
• Increase the amount and visibility of local nutritious foods.
• Develop school retail partnerships.
• Build food retail capacity to provide programs through partnerships.
• Offer low cost, simple, and easily transferable programs using pre-developed resources.
• Smaller, independent, or locally owned stores may be more autonomous, community minded, and interested in partnerships with local health professionals.
• Include grocery store initiatives as part of community-wide health promotion campaigns.
• Provide in-store health services, which can include Registered Dietitians.

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