Data-Driven Public Health Planning to Increase Access to Healthier Food Retail in Colorado

BACKGROUND: In 2013, staff at the Colorado Department of Public Health and Environment used existing and new data sources to plan a strategy to increase access to healthier food retail as part of CDC’s new funding for “State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity, and Associated Risk Factors and Promote School Health.” A key objective is to increase the number of small retail venues (e.g., corner stores, gas stations) that sell healthier food options in underserved areas.

METHODS: The team reviewed existing literature and best practices to prioritize criteria for targeting geographic areas and populations. A pilot county was selected using county-level prevalence of obesity from the Behavioral Risk Factor Surveillance System and qualitative data on the local health department’s capacity to assist. The next decisions were to select census tracts and food retailers, based on data from U.S. Department of Agriculture, food retail licensing, U.S. Census, Colorado Department of Education, Farm to School Initiative, and Google Maps. The team also conducted a population-based survey by mail, email, and telephone using Colorado’s Tobacco Attitudes and Behaviors Survey respondent registry (N=8,961) to enhance the methods for the pilot and plan expansion of the strategy.

RESULTS: The pilot county had an obesity prevalence of 25% in 2010–2012, one of seven counties in this 64-county state that had significantly higher prevalence than the state overall. Its local public health department identified obesity as a priority, and its strategy-specific capacity was “above average.” Of the 29 census tracts in the county that had no large healthy food retailer, ten tracts had at least 8% of its population below the federal poverty level. After assessing the built environment with satellite view maps, proximity to a middle school or high school, and nearby existing food distribution infrastructure, the team chose two tracts where they contacted ten small retailers. The team applied survey results on attitudes, behaviors, and barriers to buying healthy foods and beverages to design a tiered voluntary certification program for retailers.

CONCLUSIONS: Existing and newly collected data have enhanced efforts to increase access to healthier food retail in Colorado through data-driven decisions to target populations and recruit small food retailers. These data and lessons learned from the pilot efforts are being used to increase the number of small food retailers that sell healthier food options in underserved areas within and outside of the pilot county.