It’s Easiest to Find Healthy Food in Cafeterias and Vending Machines of These Cities

In many cities, healthy food can be hard to find, especially in low-income neighborhoods where grocery options are limited. The dearth of healthy options has spurred various local initiatives, from banning dollar stores to establishing community farms. 

Now, cities are turning their attention and investigating what options they make available in their own venues, such as cafeterias and vending machines in parks, as well as the food offered in sports arenas, airports, hospitals, senior centers, child care facilities, and homeless shelters.

In a new report, CityHealth, an initiative of the de Beaumont Foundation and Kaiser Permanente, investigated the healthy food procurement practices of the nation’s 40 largest cities. The cities were then ranked on both their health standards, and the implementation of those standards across city-controlled food sources.

Nine cities received gold medals, awarded for having a policy mandating nutrition standards and applying them to all city contracts. Boston, Long Beach, Los Angeles, New York, Philadelphia, San Antonio, San Francisco, Seattle, and Washington, D.C. all met this standard.

Six cities received silver medals, and four bronze. To qualify for a silver medal, cities had to have a procurement policy for healthy foods, but might only apply it to vending machines and require that 75% of procured food and beverages meet the standard. For bronze, 50% of the procured food and beverages had to meet the standard. Twenty-one cities did not have strong enough policies to be ranked, or had no healthy food procurement policy. Some of the largest unranked cities were Dallas, Detroit, Atlanta, Memphis, Las Vegas, San Diego, and Portland, Oregon.

The guidelines that cities set for their health food procurement varied, but were generally based off of one of three guidelines set by the U.S. Department of Health and Human Services, the American Heart Association, or the National Alliance for Nutrition and Activity. All the guidelines aim to limit the amount of calorie-dense, nutrient-poor options, while increasing options that are healthier. Many cities limited elements like the amount of sugar, salt, and fat in products, as well as picking options that had smaller portion sizes. 

The rankings did not include nutrition standards for public schools, as those are set nationally and cities cannot adjust them. 

Shelley Hearne, the president of CityHealth, said that city officials have become interested in healthy food procurement because they are simultaneously likely to be one of the largest food purchasers in their area and often the policymakers tasked with dealing with the health challenges that stem from the obesity epidemic. “With so many issues, including obesity, cities are the front line of defense, so they have to be the leaders in innovation,” she said.

City governments have a vested interest in promoting healthy options. More than one-third of U.S. adults are obese, and more than $190 billion is spent each year on obesity-related illnesses like diabetes, cancer, and heart disease. The costs aren’t isolated to individuals—cities with the highest obesity rates pay an estimated $50 million per year in costs associated with obesity. Obesity also contributes to work absenteeism and diminished productivity.

“It’s smart to look upstream,” Hearne said. “Cities are looking now to prevention-oriented solutions that everyone can support. Health is driven by so many social determinants like education and socioeconomic status. But food procurement is a good first step for cities to take because it’s something they can fully control.”

Hearne said that cities should look to examples set by others, but understand that each municipality has unique needs and constituencies. “What works in Seattle might not work in San Antonio,” she said. “The one thing that remains the same is that more and more Americans are demanding healthier options.”

Healthier options could be fruit in refrigerated vending machines or minimally processed nuts in traditional vending machines. Cities might also swap out soda for bottled water in beverage machines. Hearne said that some vendors have argued against healthier options because they think revenue will go down, but she said data points in the opposite direction. Chicago, for example, spent 15 months trying out healthier options in their park vending machines and found that the average machine’s monthly sales increased from $84 to $371.

The push for healthier options doesn’t just appear in Democratic-controlled cities, as Hearne said some might assume. “A lot of these policies have bipartisan support because they’re common sense,” she said. “This has happened in cities with Republican mayors and gotten widespread support in city councils. It’s not a ‘nanny state’ policy, it’s about making sure people have more choices.”

Often the momentum for these proposals builds in the office of a city’s health commissioner, who will then seek buy-in from other city agencies. Dr. Oxiris Barbot, the health commissioner in New York, was one of the officials who led the procurement initiative, part of the city’s quest to reduce childhood obesity rates because of its focus on food sources available to low-income residents. “We are proud that New Yorkers have greater access to affordable, healthy foods,” she said. “We strive to make sure that every New Yorker has access to a healthy diet regardless of income. The food we eat can change our health.”

Hearne said that leaders like Barbot are “connecting the dots” between what communities want and what makes sense economically. “This is really ramping up across the country, and I think we’ll see it take off in a lot more cities soon,” she said.