Exploring the effects of formalised, targeted municipal food planning initiatives on access to healthy food

Over the past sixty years, many cities in the United States have experienced the evaporation of independently owned neighbourhood grocery stores and the proliferation of large, full-service suburban supermarkets, leaving behind `grocery gaps' in central cities. This phenomenon, influenced by powerful economic forces, has made access to healthy food a challenge for some in these food insecure areas. In addition, easy access to fast-food restaurants, higher food prices, lower quality food and the lack of transportation has contributed to glaring health disparities where higher incidences of diet-related diseases are evident in low income and largely minority communities. Often policies designed to address the negative health outcomes and co-related `grocery gaps' focus on availability, affordability and quality of food in neighbourhoods. Few address other psychosocial components of food access. This mixed-methods study extends our understanding of access by exploring five dimensions of access: acceptability, accessibility, accommodation, affordability and availability in a study of four neighbourhoods in Louisville, Kentucky. Through spatial analysis, analyses of stakeholder interviews and ANOVA tests of questionnaire results, I found that the neighbourhood and living in an initiative area affected residents' perception of availability of fruits and vegetables. In addition, residents' perception of accommodation was affected by age. Race, sex, income, food cost, receiving food assistance and vehicle access did not significantly affect access as perceived by participants. Furthermore, access is enhanced through cultural norms and relationships, including relationships among corner stores, corner stores and families, and among neighbourhood residents. Successful corner store initiatives to improve access to healthy food in urban areas should include objective and perceived components of access as well as a temporal component that incorporates inter- and intra-community relationships among neighbourhood residents, corner stores and wider community stakeholders. This relationship amongst the objective, perceived and temporal components of access is conceptualised as the `Three Pillars of Access'. Finally, this study also holds saliency for communicative action in critical theory of urban planning as a path to move us towards authentic and qualitatively deeper perspectives concerning healthy food access.