Cross-Sector Responses to Obesity: Models for Change: Workshop Summary (2015)

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Sustainability

Donald Hinkle-Brown approached the topic of sustainability from his perspective as president and chief executive officer of The Reinvestment Fund (TRF), a certified Community Development Financial Institution (CDFI) that builds wealth and opportunity for low-wealth people and places through the promotion of socially and environmentally responsible development. Hinkle-Brown noted that TRF has $1.3 billion in cumulative investments and loans throughout the mid-Atlantic states and currently manage $738 million in capital, with more than 850 investors, approximately 500 of whom are individuals.

A CDFI is a specialized financial institution working in market niches that are underserved by traditional financial institutions, Hinkle-Brown explained. CDFI certification is a designation conferred by the CDFI Fund and is a requirement for accessing financial and technical award assistance from the U.S. Treasury. CDFIs are required to maintain accountability to their defined target markets and are rated by the organization Aeris. TRF is one of only five CDFIs in the country with the top Aeris rating, Hinkle-Brown noted.

TRF finances a variety of projects and activities in such areas as food access, health care, education, and housing. It brings together people, financing, capacity, and data, with a particular focus on the measurement of outcomes. “If you’re missing one of those components,” said Hinkle-Brown, “your effort will be hampered.”

CDFIs do not fund giveaways, Hinkle-Brown emphasized. By underwriting loans and providing grants, it funds profitable businesses, which in turn builds sustainability. (An example of such a profitable business is described later in this chapter in the section on “Building Sustainability.”) “Once we have that plate spinning, we can leave and the business works,” said Hinkle-Brown. In addition, when a new idea is found to work, it can be adopted elsewhere and at a larger scale. For example, the Pennsylvania Healthy Food Access Initiative, originally financed by TRF, has since been brought to a national scale by the federal government as the Healthy Food Finance Initiative. Once the concept had been proven, said Hinkle-Brown, “we didn’t need to take the actions that we had been taking for it to promulgate.”

The Policy Solutions division of TRF combines rigorous data analysis with the ability to help its clients think spatially. For example, it has identified areas with limited supermarket access as part of its work on accessing data on communities and markets. One of its products is a tool known as PolicyMap^®, which enables government, commercial, nonprofit, and academic institutions to perform data mapping and analysis (see Figure 3-1). The tool has more than 15,000 data indicators, as well as proprietary TRF analytics, and additions to the database are made frequently.

CREATING HEALTHY COMMUNITIES

Healthy communities have several attributes that represent a convergence of intent at the intersection of community development and public health, Hinkle-Brown observed. These attributes include affordable housing, spatial analysis of the supply and demand of human resources, accessibility, livability, walkability, access to fresh and healthy foods, an environmental focus, and sustainability (see Figure 3-2). Similarly, data are undergoing a convergence through such tools as PolicyMap, the Uniform

FIGURE 3-1 The percentage of farms that sell directly to final consumers is an example of the data overlays available on PolicyMap.
SOURCE: http://www.policymap.com. Reprinted with permission from Donald Hinkle-Brown.

Data System required by the Health Resources and Services Administration, and Community Health Needs Assessments required by the Patient Protection and Affordable Care Act. This convergence of data is not new in the public health or health sector, Hinkle-Brown said, “but for community development, it’s a very new thing.” For example, new health metrics and

FIGURE 3-2 Attributes of healthy communities.
SOURCE: Hinkle-Brown, 2014. Reprinted with permission.

indicators are continually being added to PolicyMap to make the database useful for multiple practitioners.

Another ongoing convergence involves the focus of community development. It is becoming less deal oriented, more longitudinal, less focused on quantity, and more focused on impacts. Public health is undergoing a comparable shift, said Hinkle-Brown. It is becoming less a “reaction” to poor health and more an examination of the social determinants of health. It is also moving away from broad correlations into granular, actionable interventions. “My first conversation with a public health official was based on the notion, ‘We’ll just get everybody to graduate from high school, and all these things will happen.’ And while it’s a correlation that those things are true if that thing happens, it’s not actionable. You have to break it down into its integral parts.”

The transactional side of community development can be helpful in the decomposition of such problems, Hinkle-Brown added. “How do you actually do it? How do you get Bob to graduate from high school? What are the barriers to getting that done? That’s something that is much more our expertise [as a CDFI], breaking it down.”

PROVIDING ACCESS TO HEALTHY FOOD

TRF is a national leader in financing stores that provide quality fresh food at competitive prices in low-income communities. It works to reduce inequitable access to healthy foods by underwriting loans and providing grants, advocating to increase public awareness on food accessibility, conducting policy research work, and providing technical assistance services. “Our original intent was equity of access,” Hinkle-Brown observed. “We wanted low-income people in dense communities that lacked a grocery store to have equitable access to healthy foods, period. We did not attempt to lower obesity rates. We did not attempt to change the specific metrics of health in these places. We just thought it was unfair.”

Hinkle-Brown noted that as of the time of the workshop, TRF had financed 135 healthy food projects across the mid-Atlantic totaling more than $184 million. In particular, TRF’s healthy food financing program is

designed to attract supermarkets and grocery stores to underserved urban and rural communities. Different locations call for different solutions, Hinkle-Brown also observed. For example, the approaches that work in urban areas often will not work in rural areas, where different models, such as joint ownership of distribution systems, are needed.

TRF also is a leader in research on issues related to improving access to healthy foods in distressed communities. It identifies areas with inadequate access to supermarkets and analyzes supermarket competition and barriers to entry. In addition, it examines the economic reasons for the lack of supermarkets, analyzes the economic impact of new supermarket development, and studies existing programs designed to encourage people to eat and shop for healthier foods.

Hinkle-Brown provided an example of this work by describing TRF’s nationwide analysis of areas with inadequate and inequitable access to healthy foods. Areas with limited supermarket access are those whose residents must travel significantly farther to reach a supermarket than the “comparative acceptable” distance traveled by residents in well-served areas. TRF’s analysis identified 1,519 clusters around the United States, with an average size of about 9,000 people, where enough revenue opportunity exists for a store to locate in an area with limited supermarket access (CDFI Fund, 2011).

BUILDING SUSTAINABILITY

Actions based on TRF’s analysis of areas with limited supermarket access demonstrate the role of sustainability in such efforts. In Vineland, New Jersey, TRF helped finance a grocery store anchor for a 79,000-square-foot retail center in a location adjacent to two such areas. At the same time, it was able to house a Federally Qualified Health Center (FQHC) in the development. The store and FQHC are now sharing objectives around diabetes education and coordination, “which is remarkable,” said Hinkle-Brown, “in that grocers don’t normally engage with public health issues.” The FQHC has a captive audience of people shopping at the grocery store who would not normally walk into a clinic.

A different kind of example involves a grocery store in Chester, Pennsylvania, known as Fare and Square. It is a first-of-its-kind nonprofit grocery store in an area of limited supermarket access with 15,000 people. It combines the food distribution qualities of a food pantry, the distribution of at-cost donated food, and a regular grocery store to fill in the gaps. It also houses a community center to assist in signing up for the Supplemental Nutrition Assistance Program; the Special Supplemental Nutrition Program for Women, Infants, and Children; and other programs and services. And it offers a 5-week service industry training course that has helped create 40

to 50 jobs. “This is a beautiful model of a combination of free, discounted, and market-rate food in one venue,” said Hinkle-Brown.

Fare and Square is an experiment that may not be sustainable, Hinkle-Brown acknowledged. “But it is more sustaining than only doing free food.” Furthermore, it builds relationships, and partnerships built on relationships are sustainable because relationships are slow to change.