Module 6 Case Study – The Tenderloin and its Healthy Corner Store Coalition (TLHCSC) | Homework Solution

Module 6 Case Study – The Tenderloin and its Healthy Corner Store Coalition (TLHCSC)

The Tenderloin is one of San Francisco’s poorest neighborhoods, with 35% of its 35,000 residents living below the federal poverty line, compared to 14% citywide (city data, 2011). With no full-service grocery store and 70 corner stores primarily stocking prepackaged food, tobacco, alcohol, and sodas, food access is a significant problem contributing to the neighborhood’s high rates of heart disease, cancer, and premature death (San Francisco Department of Public Health [SFDPH], 2012).

The precursor to the TLHCSC evolved in 2011 out of a tobacco-free initiative. Several local groups and organizations came together after a youth-driven assessment graphically illustrated the high tobacco advertising and availability and extremely poor access to healthy foods in neighborhood corner stores. In addition to a wide range of organizational and individual members, the Coalition, which formalized the following year, included five “Food Justice Leaders” (FJLs). The FJLs are Tenderloin residents hired and trained as food systems researchers and advocates. Their detailed store assessments, resident surveys, and merchant and resident education, together with the work of the larger Coalition, have been complemented by their use of data and personal stories to effect policy change. The Tenderloin and its Healthy Corner Store Coalition

Although not a formal Coalition leader, a respected member, who earlier had helped catalyze partnerships in the neighborhood was selected as an influential champion.  She was particularly helpful in spurring partnerships across neighborhoods.

In the Tenderloin, it was found that multiple agencies were attempting to address, independently and in their own ways, the problems of food access, alcohol and tobacco, safety, and preventable diseases. The Tenderloin and its Healthy Corner Store Coalition A sense of urgency was identified as a map was developed with images of a full or half apple or, in the great majority of cases, a rotten apple core, signifying quality and availability of healthy food, tobacco advertising, and related factors. The “apple map” was presented to city agencies and others, who were alarmed by the findings.

Figure 2. Composition of the Tenderloin Healthy Corner Store Coalition.

The importance of a single backbone organization, with dedicated fiscal and other resources to enable staff to devote sufficient time to the work was recognized and created.  A subsequent large grant enabled 50% salary support for a project coordinator and other resources for a single backbone organization.

The development of a process for collaboration, was well demonstrated by the Coalition. The backbone organization arranged for meeting space for monthly and weekly Coalition and FJLs meetings.  A nine-member Steering Committee was established, which met monthly to develop an agenda for the upcoming Coalition meeting that reflected new developments and ongoing concerns. The Tenderloin and its Healthy Corner Store Coalition The Coalition co-leads were described as effective co-facilitators of these meetings with a diverse range of people. Decision making concerning important issues was undertaken by the full Coalition through open discussion, followed by a majority vote.

Movement toward a shared goal occurred prior to formalizing the Coalition, born of the members’ unifying belief that “food is a health equity issue”. The fact that 80% of survey respondents reported that they would buy healthy food locally if available and affordable, and not in venues with a plethora of tobacco and alcohol products and advertising, were seen by the Coalition as underscoring the need for healthier, more comprehensive food options locally, which could restore lost revenue for the neighborhood. The Tenderloin and its Healthy Corner Store Coalition

The common agenda was to improve the quality of foods available in a way that put decision making in the residents’ hands and kept revenue in the community. Although members worked toward the goal in different ways, all got on board. The Tenderloin and its Healthy Corner Store Coalition

A 54-item “Corner Store Standards for Health and Sustainability Tool,” was developed and trialed as the approach for shared metrics and measurement.  The findings were then translated into a “Shopping Guide” for local residents. The Guide included photos of each store, its one- to four-star rating, “healthy highlights” such as availability of whole grains, and acceptance of food stamp electronic benefits. The Tenderloin and its Healthy Corner Store Coalition

Although shared measurement of the Coalition process has been largely limited to informal check-ins at monthly meetings, more formal evaluative processes will begin in 3 years.

Building community will was done through the FJLs by returning to all stores assessed with individualized feedback packets, the Shopping Guide, and resources for improving healthy food sales and future guide ratings.  This was repeated a year later.   More opportunities for interested stores to apply for help with store redesign was also provided. The Tenderloin and its Healthy Corner Store Coalition

A refinement process was conducted that included a more detailed assessment of the collaborative’s process and how it might be improved. For the grand opening of the first redesigned store, Coalition members decided with the store owner to have this launch coincide with the Tenderloin’s “Sunday Streets.” A daylong celebration showcasing the neighborhood and its businesses and offered entertainment. There was discussion at the event regarding a city Soda Tax initiative, which, if passed, would have provided a major new source of funding for the program. The Tenderloin and its Healthy Corner Store Coalition

The Coalition spent time reflecting on the CI process:

• There is “a real collaboration between agencies involved, key people, and community members.”
• Seven major languages are spoken in the neighborhood and parts of the community could not be engaged because of linguistic barriers. The Tenderloin and its Healthy Corner Store Coalition (TLHCSC)
• The striking diversity of Coalition members in income, education, race/ethnicity, age, and resident versus outsider status also sometimes led to tensions at meetings, based in part on power differentials.
• The cochairs and other members proved adept at ensuring broad and respectful participation, occasional outbursts occurred, sometimes necessitating mediation. The Tenderloin and its Healthy Corner Store Coalition
• Coalition participants overwhelmingly stressed a feeling of community and safety in the group, including feeling that they could safely air disagreements yet be treated with respect. The Tenderloin and its Healthy Corner Store Coalition
• Funding has proven to be a major obstacle.  A new 3-year grant from the Tobacco-Related Disease Research Program has been received with most funds dedicated to the backbone organization and the Coalition.
• City failed to pass a soda tax that would have greatly increased annual funding for this work.
• Engaging some of the neighborhood’s retail stores and helping interested small store owners shift their business model from a dependence on tobacco, alcohol, and junk food to stocking fresh and healthy items has been challenging. Limited staffing restricted their degree of participation. The Tenderloin and its Healthy Corner Store Coalition
• The participation of 56 of the 70 corner stores in the first assessments and follow-up feedback and education sessions with FJLs was impressive and spoke. The Tenderloin and its Healthy Corner Store Coalition
• Much of the Coalition’s focus has been on the “short-term sustainability” needed to keep strategies in place (e.g., building leadership and a strong community base, and getting buy-in from key decision makers). There is evidence of contributions to longer term sustainability and community and policy change as Coalition members were asked to serve on City efforts to change food, beverage, and tobacco environments.
• There was an increase in the number of corner stores improving their ratings on the FJLs’ annual store assessments, which translated into improved ratings in the Coalition’s “Shopping Guide” for residents. The number of stores with just one star decreased from 12 to 3; the number with two stars declined from 31 to 24, while the number of three-star stores nearly doubled, from 12 to 23; and the number with all four stars increased from 1 to 2. The Tenderloin and its Healthy Corner Store Coalition

Write a 2-page paper outlining how the use of the Collective Impact methodology effected the success of the Coalition’s work.  Also discuss what you believe could have improved the outcome of this work.

The Collective Impact Model and Its Potential for Health Promotion: Overview and Case Study of a Healthy Retail Initiative in San Francisco | The Tenderloin and its Healthy Corner Store Coalition

Johnna Flood, MPH, Meredith Minkler, DrPH, MPH, Susana Hennessey Lavery, MPH, 

Jessica Estrada, BS, Jennifer Falbe, ScD, MPH | The Tenderloin and its Healthy Corner Store Coalition

Health Education & Behavior, Volume: 42, issue: 5, pages 654-668

https://journals.sagepub.com/doi/10.1177/1090198115577372