Skip to main content

Bringing Healthy Retail to Urban “Food Swamps”: a Case Study of CBPR-Informed Policy and Neighborhood Change in San Francisco


In urban “food swamps” like San Francisco’s Tenderloin, the absence of full-service grocery stores and plethora of corner stores saturated with tobacco, alcohol, and processed food contribute to high rates of chronic disease. We explore the genesis of the Tenderloin Healthy Corner Store Coalition, its relationship with health department and academic partners, and its contributions to the passage and implementation of a healthy retail ordinance through community-based participatory research (CBPR), capacity building, and advocacy. The healthy retail ordinance incentivizes small stores to increase space for healthy foods and decrease tobacco and alcohol availability. Through Yin’s multi-method case study analysis, we examined the partnership’s processes and contributions to the ordinance within the framework of Kingdon’s three-stage policymaking model. We also assessed preliminary outcomes of the ordinance, including a 35% increase in produce sales and moderate declines in tobacco sales in the first four stores participating in the Tenderloin, as well as a “ripple effect,” through which non-participating stores also improved their retail environments. Despite challenges, CBPR partnerships led by a strong community coalition concerned with bedrock issues like food justice and neighborhood inequities in tobacco exposure may represent an important avenue for health equity-focused research and its translation into practice.

This is a preview of subscription content, access via your institution.


  1. Farley TA, Sykes R. See no junk food, buy no junk food. New York Times, 2015; Opinion.

  2. Powell LM, Slater S, Mirtcheva D, Bao Y, Chaloupka FJ. Food store availability and neighborhood characteristics in the United States. Prev Med. 2007;44(3):189–95.

    Article  PubMed  Google Scholar 

  3. Farley T, Rice J, Bodor JN, Cohen D, Bluthenthal R, Rose D. Measuring the food environment: shelf space of fruits, vegetables, and snack foods in stores. J Urban Health. 2009;86(5):672–82.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Minkler M, Falbe J, Lavery Hennessey S, Estrada J, Thayer R. Improving food security and tobacco control through policy-focused CBPR. 3rd ed. San Francisco, CA: Jossey-Bass; 2018.

    Google Scholar 

  5. Harder and Company Community Research. Community Health Status Assessment: City and County of San Francisco. Prepared for: San Francisco Department of Public Health. 2012. Accessed 1 June 2017.

  6. U.S. Census Buereau. 2011-2015 5-year American community survey. (San Francisco overall and census tracts 122.01-125.02). Available at: Accessed October 12, 2017.

  7. Flood J, Minkler M, Hennessey Lavery S, Estrada J, Falbe J. The collective impact model and its potential for health promotion: overview and case study of a healthy retail initiative in San Francisco. Health Educ Behav. 2015;42(5):654–68.

    Article  PubMed  Google Scholar 

  8. Kingdon JW. Agendas, alternatives, and public policies. 2nd ed. New York: HarperCollins College Publishers; 1995.

    Google Scholar 

  9. Bardach E, Patashnik EM. A practical guide for policy analysis: The eightfold path to more effective problem solving. 5th ed. Los Angeles, CA: CQ Press; 2016.

  10. Birkland TA. An introduction to the policy process: Theories, concepts and models of public policy making. 3rd ed. New York, NY: Routledge; 2014.

  11. Cacari-Stone L, Wallerstein N, Garcia AP, Minkler M. The promise of community-based participatory research for health equity: a conceptual model for bridging evidence with policy. Am J Public Health. 2014;104(9):1615–23.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Vasquez VB, Lanza D, Hennessey-Lavery S, Facente S, Halpin HA, Minkler M. Addressing food security through public policy action in a community-based participatory research partnership. Health Promot Pract. 2007;8(4):358.

    Article  Google Scholar 

  13. Yin RK. Case Study Research: Design and Methods. 5th ed. Los Angeles, CA: Sage Publications; 2014.

  14. South East Food Access. SEFA Retail Standards for Health and Sustainability. Available at: Accessed September 9, 2017.

  15. Mabachi NM, Kimminau KS. Leveraging community-academic partnerships to improve healthy food access in an urban, Kansas City, Kansas, community. Prog Community Health Partnersh. 2012;6(3):279–88.

    Article  PubMed  Google Scholar 

  16. Butler D, Aboelata M, Cohen L, Spilker S. Advancing health equity in tobacco control: summit proceedings. Paper presented at: Health Equity Summit. 2013; Sacramento, CA. Accessed 19 May 2017.

  17. Weinfield NS, Mills G, Borger C, et al. Hunger in america 2014: national report prepared for feeding America. Westat and the Urban Institute. 2014. Accessed 20 June 2017.

  18. Estrada J, Mathews G. Finding the good apples in the Tenderloin: Tenderloin youth and new community coalition launch healthy retail program. Unpublished press release., 2012.

  19. Hennessey Lavery S, Smith ML, Esparza AA, Hrushow A, Moore M, Reed DF. The community action model: a community-driven model designed to address disparities in health. Am J Public Health. 2005;95(4):611–6.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gomez A, Loresca E, Myer F, Payan K, Sanseau E, Selpides P. Healthy foods at the corner store: a community project by the Tenderloin Healthy Corner Store Coalition (Unpublished report for the PRIME program). Berkeley, CA: University of California, Berkeley, Joint Medical Program; 2013.

  21. Kim J. Supervisor Jane Kim, District 6: Newsletter Archive. Available at: Accessed September 9, 2017.

  22. Hagan E, Rubin V. Economic and community development outcomes of healthy food retail. PolicyLink: Oakland, CA; 2013.

    Google Scholar 

  23. McDaniel PA, Minkler M, Juachon L, Thayer R, Estrada J, Falbe J. Merchant attitudes toward a healthy food retailer incentive program in a low-income San Francisco neighborhood. International Quarterly of Community Health Education. (in press).

  24. Garcia AP, Minkler M, Cardenas Z, Grills C, Porter C. Engaging homeless youth in community-based participatory research: a case study from Skid Row, Los Angeles. Health Promot Pract. 2014;15(1):18–27.

    Article  PubMed  Google Scholar 

  25. Vasquez VB, Minkler M, Shepard P. Promoting environmental health policy through community based participatory research: a case study from Harlem, New York. J Urban Health. 2006;83(1):101–10.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Silver M, Bediako A, Capers T, Kirac A, Freudenberg N. Creating integrated strategies for increasing access to healthy affordable food in urban communities: a case study of intersecting food initiatives. J Urban Health. 2017;94(4):482–93.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ozer EJ, Lavi I, Douglas L, Wolf JP. Protective factors for youth exposed to violence in their communities: a review of family, school, and community moderators. J Clin Child Adolesc Psychol. 2017;46(3):353–78.

    Article  PubMed  Google Scholar 

  28. Dinour LM, Kwan A, Freudenberg N. Use of comparative case study methodology for US public health policy analysis: a review. J Public Health Manag Pract. 2017;23(1):81–9.

    Article  PubMed  Google Scholar 

  29. Black C, Moon G, Baird J. Dietary inequalities: what is the evidence for the effect of the neighbourhood food environment? Health Place. 2014;27:229–42.

    Article  PubMed  Google Scholar 

  30. Guthrie K, Louie J, Foster CC. The challenge of assessing policy and advocacy activities: moving from theory to practice. Los Angeles: The California Endowment; 2006.

    Google Scholar 

  31. Anguelovski I. Healthy food stores, greenlining and food gentrification: contesting new forms of privilege, displacement and locally unwanted land uses in racially mixed neighborhoods. Int J Urban Reg Res. 2015;39(6):1209–30.

    Article  Google Scholar 

  32. Minkler M, Garcia A, Rubin V, Wallerstein N. Community-based participatory research: a strategy for building healthy communities and promoting health through policy change. PolicyLink: Oakland; 2012.

    Google Scholar 

Download references


The authors gratefully acknowledge our partners at the Tenderloin Healthy Corner Store Coalition and, particularly, the Food Justice Leaders, without whom this work would not have been possible. We thank, as well, the Tenderloin Neighborhood Development Corporation, the San Francisco Department of Public Health, the SF Office of Economic and Workforce Development, and Sutti & Associates. Particular thanks are due to Gladis Chavez, Susana Hennessey-Lavery, Norval Hickman, Phillip Gardiner, Sandra Witt, Judi Larsen, and Anthony Iton for their belief in and support of this work.

Funding Information

This research was supported by the University of California Tobacco-Related Disease Research Program (TRDRP) grant #23AT-0008 and a gift from The California Endowment. JF’s work was supported in part by the American Heart Association grant #14POST20140055 and the National Institute Of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number #K01DK113068. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Jennifer Falbe.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Minkler, M., Estrada, J., Thayer, R. et al. Bringing Healthy Retail to Urban “Food Swamps”: a Case Study of CBPR-Informed Policy and Neighborhood Change in San Francisco. J Urban Health 95, 850–858 (2018).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • Tobacco
  • Community-based participatory research
  • Health inequities
  • Healthy retail
  • Corner stores
  • Small stores
  • Municipal health policy
  • Nutrition
  • Food swamp
  • Food environment