Researchers, policy makers, and advocates of public health are increasingly interested in local food environments (i.e., sources of foods within communities) as mechanisms to improve community nutrition and health.1–4 Improved nutrition and health may follow from increasing access to healthful foods and/or by limiting access to less-healthful foods.5
“Healthful” foods can be variably defined but, for the purposes of this commentary, a reasonable-if-not-comprehensive definition might be foods from plants--the living botanical kind, whereas “less-healthful” foods might be products from plants--the industrial processing kind. In other words, healthful foods would include, for example, fruits, vegetables, whole grains, and nuts, consistent with dietary guidelines;6 less-healthful foods would include processed meats, refined items, and concoctions full of added sugars, fats, and/or sodium: i.e., ultra-processed products.
To limit access to ultra-processed products and expand access to more-healthful items, community strategies commonly focus on the placement of restaurants and food stores. Such strategies include restricting locations for fast-food outlets,7,8 promoting supermarket development,8–11 and attracting grocery stores to neighborhoods.7,8,10,11 These strategies have a rational basis given the predominant role restaurants and food stores can play in people’s overall food purchasing.12 Indeed, interventions focused on siting food stores and restaurants might reasonably benefit community nutrition and health.
However, food-store and restaurant strategies have important limitations. One limitation relates to assumptions about the healthfulness of offerings. For example, supermarkets are usually thought of a “healthful” food sources, yet supermarkets can be principal suppliers of less-healthful fare (e.g., salty snacks, candies, sugar-sweetened beverages).13,14 Conversely, fast-food restaurants are usually thought of “unhealthful” food sources, yet many fast-food outlets offer healthful options such as fresh fruit and green salads (and some fast-food chains even focus their entire business models on healthier offerings15,16). Additional limitations of strategies based on the placement of food stores and restaurants include requirements for substantial capital, physical space, developer buy-in, and/or corporate or political will to bring change.
Bringing change--specifically towards healthier food access in communities--might come more easily through supplemental approaches having fewer practical barriers. Lower-barrier approaches include those focused on other community sources of food.
Storefronts Beyond Food Stores and Restaurants
Community sources of “food” (which, for the purposes of this commentary, also includes beverages) can be diverse. Although food stores (especially supermarkets) and restaurants (especially fast-food outlets) are by far the most-studied among local food sellers,17–19 other sources of foods in communities can include a wide variety of storefront businesses. These businesses might range from gas marts, pharmacies, and dollar stores,20–24 to hardware stores, automobile shops, furniture stores, apparel outlets, and just about every other kind of storefront retail imaginable.25–30 Such businesses, or “other storefront businesses” (OSBs) may not primarily focus on selling food but can account for as much as a third of all storefront food options in a community.29–31 Food-selling OSBs can be comparable in number to restaurants and greater in number than so-called “food stores.”31
In fact, OSBs may be the fastest growing category of storefront food sources; food-selling OSBs nearly doubled their presence over a five-year period in one study.31 In another study (Lucan and colleagues, 2016–2017, unpublished data), it was noted that increased food-selling in a community was mostly due to existing businesses adding to their provided services (by offering food), not due to the opening of new “food stores” or restaurants.
Given the extent to which OSBs can make foods available in neighborhoods, strategies to improve community food options might focus on these storefronts. Food-selling OSBs almost all offer unhealthful items (e.g., chips, cookies, soda), yet only about 10% offer such items exclusively.29,30 More-healthful options (e.g. dried fruits, whole-grain snacks, nuts) might be made more available in OSBs through approaches tested in other settings; for example, targeting their vending machines,32,33 checkouts,34–36 or broader inventories more generally.37–39
However, OSB approaches--like the food-store and restaurant strategies mentioned earlier--are limited by the fixed geographic nature of storefront setups. The reality of being confined to set physical locations may not allow for the most flexible responses to local food-environment changes.
Yet local changes can be substantial. In one study, nearly 30% more storefronts offered food, on 22% more streets, between 2010 and 2015.31 In another study, the number of OSBs offering any unhealthful foods--and the number offering only unhealthful foods--increased over a single year by 63% and 60% respectively (Lucan and colleagues, 2016–2017, unpublished data).
In such context, trying to make OSB offerings more healthful could be a worthy pursuit. But the most nimble responses to storefront changes might not be further changing storefronts.
The Potential of Farmers’ Markets
One non-storefront approach to improve food options in a community could be farmers’ markets. Farmers’ markets have an advantage over fixed storefront businesses in being able to locate in a variety of spaces, with less investment, planning, or permanency. As such, farmers’ markets may be better able to address communities’ changing needs in settings of shifting food availability. Indeed, farmers’ markets could provide communities with paths towards healthier food access.
“Access”--first described for health care40 and later applied to local food sources1--is a concept that can encompass five related dimension: availability, accessibility, affordability, acceptability, and accommodation. Availability refers to the variety or selection of items offered. Accessibility is about physical location and hours of operation. Affordability refers to price and people’s perceptions of cost and value. Acceptability implies how well personal expectations and standards are met (e.g., as relating to food quality). Accommodation suggests the degree to which consumers’ needs are satisfied (e.g., with regard to accepted methods of payment or cultural familiarity of offerings).
While each of the access dimensions can be applied to any food source (including the storefront sources already discussed), one of the few studies to evaluate all five dimensions did so considering farmers’ markets--and compared farmers’ markets to nearby produce-selling stores.41 Findings revealed that farmers’ markets carried much smaller selections of produce than stores and had much more restricted hours; farmers markets were generally open only one day a week and often only for limited times in the middle of the workday. Also, the food at farmers’ markets was generally more expensive, and tended to be of uncommon--and perhaps culturally unfamiliar--varieties (e.g., purslane, spilanthes, lamb’s quarter, and sorrel).41 In other words, famers’ markets fell short on availability, accessibility, affordability, and accommodation. Their produce did tend to be fresher, but farmers’ markets also tended to offer and promote many items of dubious nutritional value (such as pies, cakes, cookies, donuts, and juice drinks).41
The study that uncovered these findings included all the farmers’ markets operating in a single urban county. It is of course possible that famers’ markets operating in other geographic locations might offer better “access” to healthful foods in their communities.. Research from other locales, however, does not suggest this is the case.42
Farmers’ markets could certainly play a role in improving nutritional offerings for some,43 but they might not represent an ideal response for improving access to healthier foods in general. Another non-storefront option may hold greater promise.
Mobile Food Vending as an Option
Mobile food vending is a worldwide phenomenon.44–52 Mobile vendors include operators of push carts, trucks, vans, and other vehicles from which food is sold.53 Vendors can also include those selling from informal sidewalk arrangements like tables, coolers, and blankets.53
Mobile vendors, specifically those selling fresh produce, were the subject of a recent systematic review.54 In the review, authors considered aspects of vending related to all five access dimensions: availability (produce selection), accessibility (selling locations), affordability (item prices), acceptability (perceived quality), and accommodation (e.g., methods of payment). Optimal access within each dimension was not found (or, indeed, even assessed) in all studies. Nonetheless, mobile vendors may have considerable potential within access dimensions and greater flexibility within the dimensions than other food sellers.
For example, in contrast to stationary storefronts or semi-fixed farm stands, mobile vendors often have the ability to relocate at a moment’s notice (accessibility). If a selling location is not working out, mobile food vendors can simply pick up and move. In fact, in a study of mobile food vendors in the Bronx, more than 70% of vendors had set-ups that could accommodate easy and rapid movement, and nearly 30% of vendors reported selling in more than one location--sometimes even within a given day.53
Mobility may allow vendors to be particularly responsive to changing food environments within communities. For example, if there is increasing availability of less-healthful options through storefront businesses on some streets, a mobile produce vendor might be able to come in, find a niche, and meet a community need. In contrast, for a brick-and-mortar supermarket or produce store to do the same, constructing and setting up at a new location could be a considerable and costly undertaking. Likewise for farmers’ markets, the logistics of siting in a new location would not be trivial.
Logistics of siting (accessibility) aside, mobile vendors might be better able than storefronts--or even than farmers’ markets--to experiment with other dimensions of access. For instance, when it comes to hours of operation, food offerings, and food prices (accommodation, availability, affordability), mobile vendors may be able to make changes more spontaneously; vendors often operating as individuals having flexible relationships with wholesalers.55 For brick-and-mortar storefronts, hours of operation and food offerings and prices may be more constrained by set contracts with employees and suppliers. Farmers’ market may face similar hurdles to changes in these dimensions, and additionally may be constrained by needing to feature the limited products a farm produces. In contrast, mobile vendors can more freely experiment to find the right combination of hours, offerings, and prices. Mobile vendors can rapidly evolve their business models through trial and error; they can quickly and continuously course correct within access dimensions to best, and most sustainably, meet their own needs and those of the community.
Community Benefits of Mobile Vending
Those engaged in mobile vending--as opposed to those who own stores, restaurants, and farm stands--tend to come from within the communities they serve.55,56 As such, they may have an inherently high understanding of community needs, preferences, and expectations. Mobile vendors may support cultural accommodation (and not serve as a regular reminder of economic exclusion like storefront businesses--or potentially even farmers’ markets--owned by community outsiders can57). Like other food selling, mobile vending can provide economic opportunity for residents58 and might provide additional economic benefits for communities (e.g., by generating foot traffic for other local establishments).59,60 Additionally, mobile-vending sites can serve as hubs for social engagement61 and health education.62
Regarding food offerings specifically, mobile vendors can promote demand for healthier items. For example, an evaluation of the impact of mobile produce vendors in New York City showed that the proportion of all food establishments (including fixed storefronts) selling fruits and vegetables tended to increase in areas in which mobile produce vending was present.63 The suggestion is that mobile produce vendors increase general demand for produce and prompt other businesses to offer fruits and vegetables themselves (improving accessibility and availability at a minimum among access dimensions).
Mobile vendors may have additional benefits too when it comes to healthful-food access. Vendors can make healthful foods available to residents who might otherwise have accessibility issues (e.g., due to mobility problems or lack of transportation).61 Additionally, it is possible that increased competition through mobile vending can drive down prices across all food sources; and mobile vendors can certainly, themselves, support affordability of healthier items.55
As for dietary intake, the previously referenced systematic review of mobile produce vending assessed vending’s association with produce consumption.54 The review revealed mostly direct correlations with consumption of fruit and/or vegetables, however findings were not entirely consistent. For the review, there were only a small number of published studies and all had methodological limitations (e.g., observational designs, selection bias, lack of control groups). In the future, additional research using randomized controlled trials or quasi-experimental studies would be helpful to clarify possible effects of mobile vending on dietary intake. Fortunately, some such efforts are currently underway in this regard and will be helpful moving forward.64
Mobile Vending as a Strategy Moving Forward
As it stands, mobile food vending may offer several advantages over other local food sellers for improving community nutrition and health. However, mobile vendors do not currently represent a sizeable proportion of existing food sources in communities. Vendors likely account for ≤ 10% of all food sellers, even in communities in which mobile vending is prevalent (Lucan and colleagues, 2015, 2016, 2017, unpublished data). To become bigger players on the food-access scene, there are at least two challenges mobile vendors must overcome.
One challenge is weather. Weather is a substantial issue for mobile vendors, especially those directly exposed to the elements. In one study, more than 60% of mobile vendors did not operate in the winter and about 90% of fresh produce vendors did not operate on rainy days.65 Some authors have suggested partnering with community organizations for as-needed indoor spaces during these times.54 Another solution might be greater use of enclosed set-ups for vending (e.g., selling from inside of trucks as opposed to outside from push carts); only about 20% of vendors in one study had enclosed set ups.53
A second challenge is that, currently, most vendors do not sell healthful foods like fruits and vegetables. In fact, about two thirds of all mobile vendors may offer no healthful items at all.65 Moreover, in a context of unofficial selling (a majority of vendors operating without permits or licenses53) and lack of centralized planning, vendors of healthful items like fresh produce may not locate in areas of greatest need.66,67 Fortunately, models have been developed to help optimize the placement of healthful-food vendors.68 What would be helpful now are policies to support more vendors selling healthful foods, and getting those vendors to sell in areas where the are most needed..
Among policy initiative that could help improve the number and distribution of healthful-food vendors are the following: offering preferential availability, pricing, and handling of vending permits for those choosing to sell healthful items in challenged communities; having stiffer penalties for unlicensed vendors who offer only less-healthful fare; modifying credit-history requirements towards the purchases of vehicles for produce vending (e.g. trucks for selling fruits and vegetables) and having leasing options for vendors unable to purchase vehicles outright; establishing secure affordable spaces for selling healthful items in inclement weather and for storing vending vehicles when not in use; coordinating bulk purchasing of fruits and vegetables for vendors to help keep costs down (and help keep prices charged to customers low). Additionally, cities could expand community partnerships to help create local demand for healthful foods and to help recruit new vendors. Cities could also explore establishing electronic benefit transfer (EBT) as a payment option for mobile-vendor customers having Supplemental Nutrition Assistance Program (SNAP or “Food Stamps”) benefits.
Summary
Improvements in community nutrition and health may follow from healthier food access. Strategies to support healthier food access might focus on a wide array of local food sellers. Strategies focused on placing “food stores” and restaurants could be valuable, but might be costly and complicated and lack precision with regard to healthfulness. Strategies focused on OSBs and their offerings may be logistically simpler and more precise, although--like other storefront approaches--not entirely flexible from a geographic standpoint. Farmers’ markets offer greater geographic flexibility, but may fall short in several dimensions of access for many community residents. By comparison, mobile food vending holds promise as a flexible, adaptable, and dynamic strategy to optimize healthier food access more broadly.
Currently, mobile food vending may represent a small proportion of food selling overall. “Food stores” and restaurants typically play the largest role in people’s food purchases; the role of OSBs may be increasing; farmers’ markets can be variably important. Nonetheless, food environments shift and there is potential for change. Mobile vendors may have distinct advantages that could allow them greater roles in food provision. Mobile vending may be able to address many of the limitations and deficits of other food sellers within access dimenions. Support for mobile food vending could be a viable strategy to improve community nutrition and broader community health.
Acknowledgments
The author would like to thank all the students who have contributed to work on food-environment assessments, particularly research on mobile food vending (Tara Adames, Clarissa Blanco, Joel Bumol, Aixin Chen, Ilirjan Gjonbalaj, Gustavo Hernandez, Aurora Jin, Brooke Lawrence, Evans Osei Sarpong Nduro, Salamatu Nurudeen, Charles Pan, Achint N. Patel, Kevin Sarmiento, Geohaira Sosa, Luis Torrens, Monica Varona) and research on other food sources (Mamadou Bah, Alexander Bryan, Andrew Carmona, Hilary Frankel, Rafael Frias, Zoë Ginsburg, Omar Sanon, Jason L. Seitchik, Luisa E. Sperry, and Don Yoon). The author would also like to thank collaborators who have participated in research on mobile food vending (William B. Jordan Andrew R. Maroko, Judith Wylie-Rosett, Clyde B. Schechter, and Renee Shanker). Thanks also goes to Tatjana Dragic, of the Einstein Office of Grant Support, for providing feedback and edits on an early draft of this manuscript. Finally, the author would like to acknowledge Matthew Shapiro, of the Street Vendor Project of the Urban Justice Center, for providing review and comments.
Funding/Support Disclosure
The author and much of the cited research are supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award K23HD079606. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Footnotes
Conflict of interest Disclosure
The author does not have any conflicts to report.
Ethical Standards Disclosure
All of the author’s cited studies were approved or considered exempt by the Albert Einstein College of Medicine IRB under federal regulations 45 CFR 46.110 and 21 CFR 56.110.
NOTE: Permissions have been given for all Acknowledgements
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