Down in the Delta

JEFF WELLS

THE DRIVE TO INDIANOLA, MISS., PASSES COTTON FIELDS, catfish farms and a host of small towns that time seems to have forgotten. This is the Delta, birthplace of the blues and a region rich in tradition. It's also one of the most unhealthy and economically depressed parts of the country. Here, fast-food restaurants reign supreme, and recipes often call for deep frying and lots of butter.

Most food retailers wouldn't even think of promoting healthful eating in the Mississippi Delta. But that's exactly what Scott Miller, co-owner of Sunflower Food Store in Indianola, is trying to do. For just over a year, he's been coordinating in-store classes and health screenings, retooling recipes and introducing natural and organic products to customers. It's his way of giving back to the community where he grew up, of trying to help a population that's ridden with obesity and disease.

It's also a constant source of frustration.

“I think in many parts of the country, people are migrating toward products that are better for them,” said Miller. “But that's not happening in our town, and I don't think it's happening in many places, quite frankly.”

Sunflower's predicament may be one of the more extreme cases on record, but Miller's challenge is one that supermarkets across the country face, in one form or another. It's a realization that's made after the glowing market reports fade, the perky magazines are put aside and the trade shows close up: Wellness is a goal not every consumer shares.

THE SUNFLOWER BLUES

Like many small towns in America, Indianola has had its fair share of the blues. B.B. King was born and raised here, and still comes back every year to play a concert at the famous Club Ebony on Hannah Street. Middle- and upper-income jobs also once called the town home, but they left along with the companies that provided them. One, the Lewis Grocer Company, which Miller's grandfather and great-grandfather ran, sold out to Supervalu in 1965 and saw all of its top-paying positions move to the regional office in Atlanta. Another was Modern Tool and Die, which manufactured lawn mowing equipment and other metal parts. Their old factory now sits vacant on the east side of town.

As the average income level in Indianola shrank, fast-food restaurants started moving in. When McDonald's came to Indianola in the '70s, the news was splashed across the front page of the local newspaper. Nowadays, fast-food restaurants are anything but newsworthy. Highway 82, the town's main strip, is a veritable United Nations of fast food: McDonald's, Burger King, Wendy's, Sonic, Popeye's, Taco Bell, Pizza Hut, Kentucky Fried Chicken and others line the road.

“For a town our size, we have a disproportionate number of fast-food restaurants,” said Draughon McPherson, a dietitian and adjunct professor at nearby Delta State University who helps Miller with his in-store health programs.

And Indianola, which has a population of just 12,000, isn't alone. Mississippi as a whole is the poorest state in the country, with 21% of individuals living below the poverty line, according to statistics from the U.S. Census Bureau. Low income, along with the rise of fast-food establishments and a penchant for fattening — but delicious — Southern cooking traditions have all combined to make it the least healthy state in the union. It's been the leader in obesity rate since 2004, with currently 32% of the state's population classified as such, according to the Centers for Disease Control.

Zoom out further, though, and it's apparent that this is also a nationwide problem. In 1985, only seven states had obesity rates of 10% to 14%. The rest lay below this threshold. Now, every state except for one — Colorado — has an obesity rate of at least 20%. Three, including Mississippi, have rates of more than 30%.

There's clearly a need for companies and organizations to step up and address the problem. Miller, his father Jerry — who also owns the store — and the rest of the team saw this. They felt that, as a main source of food for the town, Sunflower had a responsibility to help the people of Indianola eat better. They also saw the way health and wellness was growing in other parts of the country. Organic products have seen double-digit growth over the past several years and, according to a recent report released by the American Dietetic Association, 43% of the population is currently practicing a healthy diet and regular exercise. Compare that to 1993, when less than 25% said they were eating right and staying active.

Maybe, just maybe, Miller thought, they could tap into that success in Indianola.

“It just seemed natural for us to try to do this,” Miller said.

One of their first efforts was an in-store presentation that covered basic nutrition concepts and included samples of healthful alternatives to conventional favorites, like baked chips and diet soda. McPherson had her students develop the program as part of their coursework, then work with Sunflower Food Store manager James Jeffcoat on lining up store products for the program.

To promote the event, the store ran reminders in its ad circulars. The Millers also bought radio ads and newspaper spots. The big day came.

“There was no interest. It just fell flat,” said Miller.

Singin' a New Tune

Selling healthful foods can be hard work, especially when the need to please investors and the bottom line looms. In places like Indianola, where genuine efforts to promote healthy habits fall short, the incentive to try again — or to try at all, for that matter — seems thin.

“If we went into the cafeteria here and took out all the fried food and salt and meat fat and that kind of stuff, you'd probably start a small rebellion,” said McPherson.

And so Sunflower Food Store carries its fair share of Southern staples. There are catfish steaks, chicken wings and pork spareribs, which were recently advertised at $1.19 per pound. The hot plate line carries fried chicken, rice and gravy, cornbread, green beans, mashed potatoes and much more; $4.29 buys an entree, two sides and a roll or cornbread.

Food culture in the Mississippi Delta, with its heavy use of oils, spices and fats, certainly puts up one of the country's strongest barriers to healthful eating. But it's not the only community with a challenge. Consumers in urban and rural areas throughout the country prize flavorful sauces, fried foods and soft drinks. Although the U.S. Department of Agriculture's Dietary Guidelines for Americans recommends people consume 2 cups of fruit and 2.5 cups of vegetables per day, studies show that most Americans achieve barely half those amounts.

Suzy Weems, who chairs the center for family and consumer sciences at Baylor University, Waco, Texas, believes that the problems in Indianola and the Delta are a microcosm of the country as a whole. She's researched the issue extensively, and recently she worked on establishing nutrition programs in three low-income counties on the eastern edge of Texas.

“The culture in a lot of these areas is still one where feeding is a responsibility, and the size of the individual reflects the size and abundance of the provider,” said Weems. “That's still one of the biggest conflicts out there.”

The growth of quick-service and chain restaurants hasn't helped. According to the U.S. Department of Labor Statistics, the number of foodservice establishments in America increased from 491,000 in 1970 to 878,000 in 2004. Today, meals away from home account for almost half of Americans' food budgets, compared with 26% in 1970.

With their dollar menus and value meals, fast-food restaurants thrive in places like Indianola, where the median household income is just over $26,000. Studies show that these establishments also disproportionately target minorities. Almost three-quarters of the population in Indianola is black, according to census data.

“It's hard to make healthy choices when all the signals and supports in your environment tell you to do just the opposite,” said Sonya Grier, who has researched the issue as an associate professor of marketing at American University in Washington.

Limited dietary choices for low-income and minority consumers extend to many of the country's urban areas, such as Baltimore, Los Angeles and Detroit, where in some neighborhoods produce and other healthful options, not to mention grocery stores themselves, are hard to find. A study conducted earlier this year by New York City's Department of Mental Health and Hygiene found that in the generally poor neighborhood of Harlem, bodegas and convenience stores — which typically carry inferior produce and few healthful offerings — outnumber supermarkets more than 9 to 1. The more affluent Upper East Side, on the other hand, has a ratio of less than 2 to 1.

Diana Cassady, an associate professor of public health sciences at the University of California-Davis, acknowledged the difficulties for retailers in selling to lower-income areas.

“Economically, it's hard,” she said. “More checks bounce, it's difficult to find a large enough space to accommodate parking. There's no doubt there are financial barriers.”

Ultimately, consumers and retailers are sharing the burden of what has become the high cost of eating healthy. Government subsidies for staple crops used in calorie-dense, processed foods have kept the costs of these products low, while the price of fruits and vegetables has steadily risen over the years. A study that Cassady conducted earlier this year found that many low-income families would have to spend beyond their food budgets in order to meet the latest dietary guidelines. Another, from the University of Washington's Center for Public Health Nutrition, Seattle, showed that the average price of fresh fruits and vegetables jumped by 20% between 2004 and 2006, while the price of candy and other unhealthy snack foods remained relatively stable.

A Second Helping

For Scott Miller, the paltry turnout at Sunflower's first health seminar was discouraging. But he didn't give up. He and McPherson went back to the drawing board.

“We decided we would offer blood pressure screenings,” Miller said. “People would come to the store, get their blood pressure checked, and then on the back end we would talk about what people can do to lower their blood pressure, eat healthier, that sort of thing. That was a little more successful. We had people come in because they wanted to get tested for free.”

The event taught Miller a few things as well. He knows now that the best way to encourage resistant or less-affluent consumers is to craft initiatives that cater to a specific need, and to their culture. It takes research, and an intimate knowledge of a store's customer base, but the potential is there to foster a safe environment and do right by the communities that supermarkets serve.

Studies show that, given a leg up, consumers who might not normally buy healthful products will in fact do so. The U.S. Department of Agriculture's Economic Research Service issued a report this year that showed low-income consumers will purchase more fresh fruits and vegetables when given a small monetary boost.

“It appears that a household's income does not need to rise much higher than 130% of the poverty line — a cutoff for the Food Stamp Program — before the average household allocates additional resources to fruits and vegetables,” according to the report.

Extending a helping hand doesn't just mean offering economic incentives. It could also be something as simple as a free ride to the store. Cassady discovered that, in the low-income Hispanic neighborhoods around Los Angeles that she's studied, where supermarkets are few and far between, stores that provided shuttle service saw an increase in sales and customer loyalty.

“I've talked to several store managers there about their shuttling programs, and they say it more than pays for itself because people are able to buy more food,” explained Cassady.

Giving customers a leg up also means understanding what motivates them. For promotions and product offerings inside the store, Weems said, it's best to take a gradual approach that focuses on foods that are familiar to customers. To start with, she recommended healthy alternatives like baked potato chips, diet soda and baked chicken. When offering recipes or meal ideas, keep things simple by limiting preparation to five steps or less.

“You have to go into their core foods and address it at that point,” explained Weems. “You don't change a behavior by just letting people know what's healthy. You have to make it real to them.”

Weems also pointed out that, because a supermarket alone can't change a community's attitude towards health and wellness, it helps to enlist the support of local leaders. Churches and other faith-based organizations are a great example, especially in the South, she said.

“People relate to people whom they trust, so unless you're fairly acculturated and part of that group, you need to find key people in the community,” said Weems.

At Sunflower Food Store, Miller recently started offering baked chicken in the buffet line. He and the store team have also put in a natural and organic section, which they've stocked with items from Supervalu's Wild Harvest private-label line, as well as mainstream brands like organic Ragu pasta sauce. Even though these items aren't selling well right now, Jeffcoat, Sunflower's manager, said he'd like to eventually integrate them into the rest of the store.

Sunflower also now hosts several in-store screening events and classes per year. McPherson and her students give quick presentations on healthy topics from hypertension to healthy eating on a budget, at the same time offering free blood pressure, cholesterol or glucose screenings with registered nurses. If any warning signs show up, the staff will refer a customer to his or her doctor.

There's also food to taste at these events. One recent dish was a strawberry shortcake made using Diet Sprite.

“You'd be surprised at how many people had never had a diet drink,” said McPherson. “They all said, ‘Hey, this isn't bad.’”

Miller's ultimate goal is to get people in Indianola thinking preventively about their health. It's a long, uphill battle, but he and his team don't plan on giving up. He's constantly thinking up new ideas for his store: healthy lessons for kids, a program to help employees lose weight, perhaps an insurance tie-in that would offer savings he could pass along to his staff.

“I think it will take some time, and I'm committed to it for the indefinite future,” said Miller. “Even if we have some programs where very few people show up, that's not going to stop us.”