Legal and policy approaches can be important tools for achieving healthier communities. The report, The Role of Law and Policy in Achieving the Healthy People 2020 Nutrition and Weight Status Goals of Increased Fruit and Vegetable Intake in the United States, provides evidence-based information and identifies priority areas that can help communities achieve Healthy People objectives.
This Bright Spot describes how New York City used policy change to increase access to and availability of fresh fruits and vegetables in underserved neighborhoods.
Challenge: Limited access to fresh produce in some neighborhoods
In New York City, the largest and most densely populated city in the United States, accessing healthy food can be a challenge for some. Not being able to access and consume healthy foods, particularly fruits and vegetables, contributes to disparities in diet-related health outcomes like diabetes, obesity, and heart disease.1 In 2008, about 1 in 3 New Yorkers lived in a neighborhood without many grocery stores—and these neighborhoods had some of the highest rates of obesity and diabetes in the city.2,3 Among other factors, these circumstances make it harder for individuals to get the daily recommended amount of fruits and vegetables.
Strategy: Permits for mobile produce vendors
In response to these issues, the Mayor’s Office and several partners launched an effort to increase access to healthy food and decrease health disparities in some of New York’s poorest neighborhoods. The idea was both simple and full of potential: create a new class of food vendor permits for selling fresh produce.
The Green Carts initiative, launched in 2008, was a partnership between the Mayor’s Office and the New York City Department of Health and Mental Hygiene (NYC Health Department), with funding from the Laurie M. Tisch Illumination Fund (LMTIF). The idea was to expand on the existing mobile vending infrastructure to bring healthy foods to underserved areas. Although there was already a vibrant network of regulated, permitted, and licensed mobile food vendors, there was also a cap on the number of permits available, which resulted in long waiting lists for vendors.
The new policy made available 1,000 new vendor permits specifically to sell fresh, unprocessed fruits and vegetables in specific precincts where residents had low rates of fruit and vegetable intake. Kim Kessler, Assistant Commissioner within the Bureau of Chronic Disease Prevention and Tobacco Control at the NYC Health Department, says that by introducing these produce-specific vendor permits, the City aimed to increase healthy food access in low-income neighborhoods while also creating new business opportunities.
Making this policy change and then implementing the program took time, innovation, and collaboration. Initially, the Mayor’s Office and the NYC Health Department worked closely with the City Council to construct the legal framework for a new class of mobile food vending permits specifically for fresh produce within the local laws that regulate mobile vending. Other collaborators included the LMTIF, Karp Resources (which served as a consultant on the project), and local non-profits who helped with branding, promoting, and sourcing produce for the Green Carts.
Impact: Better access to fruits and vegetables
The data show that the Green Carts initiative has been successful at bringing healthy foods to underserved areas. Overall produce availability and variety has gone up in Green Cart neighborhoods compared with neighborhoods without Green Carts.4
As of 2014:5
- 71% of Green Cart customers had increased their fruit and vegetable intake.
- 63% of customers reported shopping at Green Carts at least once a week.
- 68% of these customers earned less than $50,000 a year, and 44% earned less than $25,000 a year.
Response to the Green Cart initiative has been positive according to Tom Merrill, General Counsel at the NYC Health Department. A survey by the Citizens’ Community for Children found that community members like the quality, prices, and variety of Green Cart produce.6 Many vendors used technical assistance from the program to start and market their businesses.
Research indicates that the presence of Green Carts may have also spurred supermarkets, bodegas, and other mobile vendors in the communities to either start carrying produce or expand their offerings. In the first 3 years after the initiative launched, the proportion of local businesses selling fresh produce in the neighborhoods where Green Carts were permitted increased from 50% to 69%.7
Lessons Learned: Programmatic support is key to sustainability
Adding the permits was a critical first step, but this kind of policy change needs programmatic support if it’s going to be sustainable over the long term. For Green Carts, Kessler explains, the ability to provide technical assistance for vendors in the early stages was key both to ensuring the successful launch of the initiative and creating this new market.
The need for ongoing support and technical assistance for vendors was something that the NYC Health Department didn’t initially anticipate—but vending is a difficult business, and vendors come to it with different levels of skill and expertise. So it was important to make sure that the vendors had help with things like branding and marketing, sourcing produce, understanding how the permitting process works, and connecting with local customers.
Looking Ahead: Continued evolution and vendor support
Moving forward, the NYC Health Department would like to continue to help more vendors get set up with electronic benefits transfer (EBT) equipment, which they need in order to accept Supplemental Nutrition Assistance Program (SNAP) benefits.
Although launching the initiative took a fair amount of work from multiple partners, Kessler says it’s had a positive impact. Almost 300 licensed vendors on New York’s sidewalks are making fresh, healthy produce available to neighborhoods that need it. Green Carts have offered a new resource for healthy foods in neighborhoods across New York and have provided new opportunities for vendors. Thanks to Green Carts, customers report eating more fresh fruits and vegetables and many vendors have become integral to the neighborhoods in which they sell.
Kessler and Merrill are optimistic that these changes will continue to support New Yorkers in making healthy choices and contribute to the fight against long-term health disparities.
About the Law and Health Policy Project
The goal of the Healthy People Law and Health Policy project was to highlight how evidence-based legal and policy interventions and strategies can facilitate progress toward Healthy People 2020 targets by improving community health and well-being. In addition to reports and webinars, the project included "Bright Spots," or success stories, that highlighted successful policy interventions that led to improved health outcomes. The project was a collaboration between the HHS Office of Disease Prevention and Health Promotion (ODPHP), the Centers for Disease Control and Prevention (CDC), the CDC Foundation, and the Robert Wood Johnson Foundation.
1 Crawford P, Dunning L, Kappagoda M, O’Connor JC. The Role of Law and Policy in Achieving the Healthy People 2020 Nutrition and Weight Status Goals of Increased Fruit and Vegetable Intake in the United States. Rockville (MD). Department of Health and Human Services, Office of Disease Prevention and Health Promotion (ODPHP); 2018 Sept 13. Supported by the Centers for Disease Control and Prevention, ODPHP, and the CDC Foundation through a grant from the Robert Wood Johnson Foundation. Available from: https://www.healthypeople.gov/sites/default/files/LawHealthPolicy_Report_2018.10.pdf
2 New York City Department of Health and Mental Hygiene Epiquery: NYC Interactive Health Data System - [Community Health Survey 2004]. [December 5, 2018] Available from: http://nyc.gov/health/epiquery
3 Going to Market: New York City’s Neighborhood Grocery Store and Supermarket Shortage. Presented by New York City Department of Planning. 2008. Available from: https://www1.nyc.gov/assets/planning/download/pdf/plans/supermarket/presentation_2008_10_29.pdf
4 Farley SM, Sacks, R, DAnnefer R, Johns M, Leggat M, Lim S, Konty K, Nonas C. Evaluation of the New York City Green Carts program. AIMS Pub Health. 2015;2(4):906-918.
5 Fuchs ER, Holloway SM, Bayer K, Feathers A. Innovative Partnership for Public Health: An Evaluation of the New York City green Cart Initiative to Expand Access to Healthy Produce in Low-Income Neighborhoods. Columbia University School of International and Public Affairs Case Study Series in Global Public Policy. 2014; 2(2):2. Available from: http://www.foodpolitics.com/wp-content/uploads/Green-Carts-Report-Final-June-11.pdf.
6 March-Joly J, Siegel J, Marchione, D. Green Cart Implementation: Year One. New York (NY). Citizens’ Committee for Children of New York, Inc; 2010 September. Available from: https://www1.nyc.gov/assets/doh/downloads/pdf/cdp/ccc-green-cart.pdf
7 Farley SM, Sacks, R, DAnnefer R, Johns M, Leggat M, Lim S, Konty K, Nonas C. Evaluation of the New York City Green Carts program. AIMS Pub Health. 2015;2(4):906-918.
Related Healthy People 2030 objectives: