Louisiana Public Health Initiative (LPHI), a nonprofit third-party health-care organization, runs Steps To a Healthier New Orleans for the city Health Department, which receives the annual $1.8 million budget from the Centers for Disease Control. The federal initiative, Steps for a Healthier U.S., began in 2003 and is a five-year program that awards money to communities. In 2003, the New Orleans' Health Department, with assistance from LPHI and Tulane University's School of Public Health, was granted $9 million over five years.
Dr. Amita Toprani, who works for LPHI, is the director of New Orleans' program. She says that LPHI and Tulane initially convened a community consortium of various groups from across New Orleans, which included nonprofits, local businesses, health centers and others, to decide what was the best strategy for lowering the city's high obesity rate, 22 percent, and overweight population, 33 percent.
The consortium chose a systemwide approach rather than, as Toprani describes, 'the direct: handing out of flyers, doing educational programs or the direct teaching of skills to people." People often know how to eat healthy, whether their eating choices are good or bad, Toprani says, but sometimes, especially in lower income neighborhoods, the healthy option isn't available.
'We live in a city that's very unhealthy," Toprani says. 'It's culturally acceptable to eat unhealthy, to not exercise, to be overweight. It's hard to make healthy choices. It's hard to walk to work. It's hard to go to the store and get healthy food. So we try to do a multi-prong approach and make it easier to walk to work, easier to bike around town and easier to buy healthy fruits and vegetables at the store."
While the program doesn't have the kind of funding to, for instance, build more bike paths or fresh-produce markets, it can influence and assist those who do. One of the members of the Steps team is Jennifer E. Ruley, an urban planner and environmental engineer whose office is housed at the New Orleans Department of Public Works. When that department decided to begin work on Robert E. Lee Boulevard between Marconi Drive and Wisner Boulevard, part of City Park's perimeter, Ruley suggested that for a minimal investment they could stripe a bike lane and put up signage. To save money, Ruley performed the engineering work for that part of the project. Toprani says her office also contributed to the recently completed St. Anthony walking path in the Sugar Hill neighborhood of Gentilly.
Erin Baker, assistant director at Tulane's Prevention Research Center (PRC) which collaborates efforts with the Steps office, says because they receive federal funding, the program staff can't lobby politicians, but it can advocate that legislators take a closer look at laws that create a healthier environment. Baker and Toprani both consider the passing of the Healthy Vending Act and the Physical Education Act as examples of positive legislative advocacy. The Healthy Vending Act limits the sale of certain food and beverages in public elementary and secondary school vending machines and the hours these machines can be operated. The Physical Education Act requires that all public schools, grades K-6, provide students with at least 30 minutes per day of quality moderate to vigorous physical activity.
If the words 'lobbying" and 'advocating" sound very similar, the confusion isn't lost on Baker, although she says there is one stark difference: money.
'It's actually just a legal definition, that's the difference," Baker says. 'We can't pay someone " we couldn't hire a firm to go represent our interests."
One area that Steps is interested in promoting is the availability of fresh produce. Recently, the PRC conducted a survey among predominantly low-income New Orleanians that showed that although the participants weren't eating a minimum of five servings of fruits and vegetables daily, 70 percent 'would buy" or 'might buy" fresh produce if it was available at local stores. According to the survey, purchasing fresh produce is difficult because only half of those polled own a car and only 6 percent are within walking distance of a supermarket. The survey goes on to point out that most respondents make the majority of their food purchases at convenience stores, which often do not carry fresh produce.
Steps sees the problem as environmental " and the survey supports that thinking " so the question becomes how to convince corner store owners to provide more healthy choices? For that, Steps has developed the Corner Store Initiative. Under that plan, Steps contacts corner store owners in lower-income neighborhoods and asks the owners to stock at least two new items " fruits, vegetables, low-fat dairy or whole-grain products " in their store. In exchange, Steps supplies the stores with in-store promotional items such as displays, stickers, posters and handouts, and advertises the store as a 'Steps Corner Store" in radio and newspaper commercials.
A recent stop at one of these stores, Dora's Supermarket, located at 3046 St. Claude Ave. in the Bywater, finds store owner Linda Khalaileh restocking the Corner Store Initiative display. Khalaileh is refilling the display with apples and bananas and reports that customers are buying the produce.
'It's been great," she says. 'I have to refill the stand twice a day."
A drive further downriver along the St. Claude strip toward the Industrial Canal reveals some fast-food restaurants " Captain Sal's Seafood and Church's Chicken " and some convenience stores, but no real fresh-produce grocery stores. Most of the stores are like Sunrise Store, which offers a menu of fried food, canned goods and beer, but no fresh vegetables except for a few yellow onions. Elsewhere along the strip, there are closed storefronts, indicating the need for new businesses in the area.
Larry Willis owns one of these closed buildings on the corner of St. Claude Avenue and Bartholemew Street. The building used to house a credit union decades ago and is zoned B1-A, which allows for a restaurant. Willis says that before the storm, he had several businesses interested in his property, but has only been approached by Popeyes Chicken and Biscuits since Katrina. Popeyes offered Willis a 20-year guaranteed lease on his property, provided the company can operate a drive-through window on the premises. B1-A zoning doesn't allow for drive-up windows, but property owners can apply to the City Planning Commission for conditional use that would allow it.
Willis feels the proposed restaurant will be good for the area ('I'm only trying to get something down there," he says), but local resident John Guarnieri disagrees. He has collected 35 signatures on a petition against Popeyes' plan and says he is interested in seeing a business occupy Willis' lot, but not another fast-food restaurant. Guarnieri admits that he initially was concerned about the additional traffic, trash and bothersome odor the Popeyes might generate, but now he's also thinking about the restaurant's close proximity to two area schools, Drew Elementary School and Frederick Douglass High School.
'The other issue is " and this is a grass-roots movement in certain areas and cities around the country " that neighborhoods do not want drive-through fast-food restaurants because of the health issues," Guarnieri says.
Baker and Toprani are writing letters of support for Guarnieri to challenge Willis' conditional-use application. Baker says that it's difficult to argue against any business that can add to the city's recovery, but a line should be drawn when the business negatively impacts a neighborhood's environment.
'Because we're part of the federal government, we really don't have foes, but we are definitely against saturating neighborhoods with foods that can kill you and that's just a fact," Baker says.
Citing a geographical analysis conducted in 2004 by the Tulane University School of Medicine, Baker says that on average there are 50 percent more fast-food restaurants in black, low-income neighborhoods in New Orleans than in white neighborhoods. On the other hand, Willis doesn't understand why he's 'being picked on" when, he says, 'everything on St. Claude right now is unhealthy." And for Toprani and Baker, that's just the point: How can you tell New Orleans to eat better when the only foods available are high calorie and high fat, which can lead to obesity and, in turn, an increased risk for heart disease, Type II diabetes and certain kinds of cancer?
The City Planning Commission will hear both sides of the debate on Oct. 9.
Toprani says that because programs like Steps are concerned with changes in environment and culture, success is difficult to measure. But, she says, citizen activists like Guarnieri and increased funding opportunities for programs like hers " the Robert Wood Johnson Foundation recently announced it was allocating $500 million to fight childhood obesity " demonstrate that, overall, the nation's attitude toward its health is changing. She thinks New Orleans business and civic leaders need to consider this when planning for the city's recovery.
'You don't want to be in a position in post-Katrina New Orleans to discourage anything that's going to invest into our economy," Toprani says. 'But at the same time, you don't want to open the door to things that, five to 10 years down the road, we're going to regret because we settled for the short-term gain."