Mar 16 2012
Comments

Helping Low-Income Shoppers Access Fresh, Healthy Foods at Farmers' Markets

Alison Buttenheim, PhD, MBA, an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program and assistant professor at the University of Pennsylvania School of Nursing, is lead author of a study published online this week by the Journal of the Academy of Nutrition and Dietetics. It finds Supplemental Nutrition Assistance Program (SNAP) participants redeem their benefits at higher rates at farmers’ markets when there are more vendor-operated wireless point-of-sale terminals. Read the study and listen to the authors talk about the findings.

file

Human Capital Blog: Why is it important that SNAP (food stamp) participants are able to get food at farmers’ markets? Why should we want redemption rates to increase?

Alison Buttenheim: There’s been a lot of research into the quality of diets for SNAP participants and it’s pretty clear that there’s room for improvement. They often don’t have access to fresh, affordable fruits and vegetables and other healthy food options. We’ve seen considerable policy interest in how we might change the diets of this population. One approach has been to focus on individual behavior change, but more recently there’s also been a focus on changing the food environment to increase access to healthy food in underserved neighborhoods, in the hopes that this will encourage better diets.

HCB: Why are SNAP redemption rates lower at farmers’ markets?

Buttenheim: Food assistance used to be paper coupons that you literally tore off and handed over to vendors, which made it quite easy. Now SNAP is all electronic, and participants get a card—like a credit card—that they use to redeem their benefits. Brick-and-mortar stores that participate in the SNAP program get a free point-of-sale terminal to process these transactions, and fees associated with the transactions are subsidized. But farmers’ markets rely on third party providers to supply wireless terminals and process transactions, and these providers of course charge wireless service fees and transaction fees. It’s costly. In 2009, only 900 of the 5,200 farmers’ markets in the country participated in SNAP.

HCB: Your study looked at an intervention that increased SNAP redemptions by 38 percent over a nine month period. Tell us what you found.

Buttenheim: Before our intervention, SNAP participants who shopped at the year-round Clark Park farmers’ market in Philadelphia would be issued a receipt by a vendor, and they’d have to take that to the market manager. The market manager would swipe the card for the purchase amount, and the participant would take his or her receipt back to the vendor to get the purchase. So if they made five purchases, they went through this process five times. It was quite cumbersome.

Using a grant from the U.S. Department of Agriculture (USDA), we tested a model that originated in Iowa that provides all vendors at the markets with their own wireless electronic benefits transfer (EBT) terminals to process transactions, with no costs or fees for SNAP purchases. The intervention lasted from June 2008 to February 2009. After the pilot, when we looked at SNAP purchases for that time period, we saw a 38 percent increase in SNAP sales at the market. Our evaluation models of course control for seasonal changes and for the sizable increase in the number of SNAP beneficiaries in the Philadelphia area during that time.

HCB: What do you hope will come of your findings? What should policy-makers and health professionals take away from the results?

Buttenheim: With this very simple intervention we boosted SNAP sales by more than a third. After the intervention was over and the market went back to its original singe-terminal system, sales went back down. This shows us it’s not something you can try once and hope SNAP participants get used to—this needs to be in place all the time to see an increase in redemption rates.

In interviews with farmers, we found that the costs associated with having individual wireless terminals is not something they are willing to take on themselves. Even with increased sales and the perk of being able to process any credit or debit cards on the EBT system, they felt there weren’t enough marginal sales to cover the costs of leasing their own terminals and paying the fees. This model has been subsidized in Iowa from day one, and it’s been successful there. Part of the USDA’s strategic plan is to increase the number of farmers’ markets authorized to accept SNAP, and increase SNAP redemptions at farmers’ markets. We hope policy-makers think carefully about whether farmers’ markets should have the same benefits as brick-and-mortar stores in receiving free SNAP redemption services.

We’d like to see this study replicated in other markets. Our setting—the size, the neighborhood, the part of the country—is unique, and we hope our findings will be confirmed in other markets. We see a suggestion here that this very straightforward tweak to how SNAP participants use their benefits may strongly affect sales and the quality of food they purchase.

Tags: Health & Health Care Policy, Health & Society Scholars, Healthy Food Access, Publications, Research & Analysis, Underserved Populations, Voices from the Field