Peapod: A Means for Food Justice

November 23, 2010

I admit that I have done little research before writing this post, but there is an idea that I’ve been thinking about a lot recently and may update over the next week:

The Peapod grocery delivery service could end access-related food security issues in the urban United states.

For those of you that don’t know about Peapod (i.e. for anyone that, unlike New Haven, actually has a nearby grocery store) – it’s a grocery delivery service run by Stop and Shop. You can order just about anything that Stop and Shop would usually have in their grocery stores and all your groceries will be delivered to you in plastic bags, often within 24 hours (you can pick a 2 hour delivery time window)

You can buy everything: milk, meat, fruit, vegetables, cheese, coffee, spaghettio’s, marshmallows, beer, and even items outside the common graduate student’s diet. I’ve used Peapod for a few months now and have been really happy. Others claim that bananas show up brown or the lettuce goes bad quickly. Regardless, it has made life a lot easier for me: a graduate student without a car and limited food budget.

The public health implications of this service are incredible. Low-income families often suffer in a automobile-dominated society. If you don’t have a car, you can’t drive to the grocery store. Low-income neighborhoods aren’t a great market for big supermarkets, so you don’t find many Whole Foods in inner-city Detroit. These “food deserts” are becoming a major social problem and were recently featured by a  New York Times Magazine article:

The term is generally used to describe urban neighborhoods where there are few grocers selling fresh produce, but a cornucopia of fast-food places and convenience stores selling salty snacks.

Food injustice” has become a buzzword term featured in several articles to discuss the disparities that exist in the US regarding the access to groceries:

If you don’t have access to groceries, you don’t have access to healthy foods, and therefore you don’t have access to proper nutrition. In case you haven’t read a newspaper in the past ten years: obesity is a pretty massive problem in the US, particularly affecting low-income families. If you can improve access to fresh produce, you can improve diets, you can improve health (or so the arguments goes).

Clearly, Peapod isn’t a perfect solution:

  1. There is a delivery cost that might make grocery delivery financially unavailable to the low-income families that need access to groceries. Government subsidies (or Stop and Shop philanthropy) could make this a non-issue.
  2. Without education, access means nothing. If you have access to all these new healthy foods but just buy beer and marshmallows, your health probably won’t improve (though apparently a twinkie diet can make you a lot healthier).
  3. Rural areas are still kinda left in the dust. Peapod’s grocery delivery probably is not a cost-effective way to improve access to foods to the boondocks.

But there is still a lot of potential.

I think there is an ideal pilot project here somewhere that combines:

  • food stamps
  • Peapod promotional materials
  • education materials regarding diet (including quick, cheap meals cookbook)
  • some kind of subsidy to cover delivery costs

Someone make it happen.


No One Actually Knows About Income Inequality

September 22, 2010

h/t to Paul Kedrosy for posting about an interesting income inequality article:

Dan Ariely et al. conducted a recent research study on people’s perceptions of US income inequality. They had three major findings:

  • Respondents dramatically underestimated the current level of wealth inequality.
  • Respondents constructed ideal wealth distributions that were far more equitable than even their erroneously low estimates of the actual distribution.
  • All demographic groups—even those not usually associated with wealth redistribution such as Republicans and the wealthy—desired a more equal distribution of wealth than the status quo.

Just recently in a Global Health course, we were shown the breakdown of global income inequality. It’s also pretty ridiculous. In fact, 40% of world’s wealth is owned by 1% of the population. In fact, the richest fifth of the population receives 82.7% of the total world income.


One can also see that the disparity is widening:

Data taken from (Dikhanov 2005)

In a recent Financial Times comment, Kermal Dervis (Director of the Global Economy and Development program at the Brookings Institution) argued that this global income inequality is not only immoral, it threatens future global economic growth:

Less inequality in income distribution may not only be ethically desirable – it may be a necessary condition to resolve global macroeconomic fragility and ensure more sustained growth. It is time to analyse income distribution also with a macroeconomic policy perspective.




Dikhanov, Yuri. 2005. Trends in Global Income Distribution, 1970-2000, and Scenarios for 2015. Human Development Report Office (HDRO), United Nations Development Programme (UNDP).



Top 5 Public Health Jobs (that have nothing to do with public health)

September 20, 2010

For a long time, I’ve had an idea for a post that I never fully developed. Finally, I’m going to post it. Perhaps some of the potential insights are only partially percolated in the post; regardless, we proceed.

To me, the question “How can I save the world?” always seemed to imply “How can I help the sick? How can I make people live longer, happier lives?” I’m not sure if this is a common association, but an enormous amount of impact can be made through broadly improving public health.

Almost all of the world’s greatest tragedies are issues of public health. While the discipline often focuses on disease epidemiology or health policy, other major events clearly affect the health of populations: war, climate change, mental stress, natural disasters. Objectively, public health is not just vaccinating children but bringing conflict resolution, preparing for hurricanes, improving family dynamics, paving roads, building bridges (physical and metaphorical), and improving the quality of life for large numbers of people.

Unfortunately, such a broad scope can’t really be covered in a Masters program. Instead, we learn biostatistics and memorize long lists of risk factors for cancer, infectious disease, and other behaviors that lead to sickness. (It turns out, being really poor makes being healthy really difficult).

All of these many health-related disciplines, however, need leaders. And since getting an MPH can slow people down for two years, I’ve compiled a personal list of the top five occupations that I believe achieve the most public health (i.e. save-the-world) impact.

1) Teachers
One of the most impressive correlations that exists (in my opinion) is the correlation between health and education. From a 2007 NY Times article:

The one social factor that researchers agree is consistently linked to longer lives in every country where it has been studied is education. It is more important than race; it obliterates any effects of income.

Education improves the economy, decreases risky behavior, and even cuts down smoking; not to mention the vocational training in finding stable employment and improving the economy.

2) Engineers
According to charity:water, unsafe water and lack of basic sanitation cause 80% of diseases and kill more people every year than all forms of violence, including war. The social consequences are equally destructive:

In Africa alone, people spend 40 billion hours every year just walking for water. Women and children usually bear the burden of water collection, walking miles to the nearest source, which is unprotected and likely to make them sick.

Time spent walking and resulting diseases keep them from school, work and taking care of their families. Along their long walk, they’re subjected to a greater risk of harassment and sexual assault.

In many places, water is hard to come by. There needs to be water infrastructure and to create this infrastructure we need innovative engineers. Plain and simple.

Engineers have done a lot to help the world. From the CBS Business Network:

Engineers have built more than 36,000 large dams around the globe to control floods and provide hydroelectric power, irrigation, industrial supplies, and drinking water to an expanding population and economy.

3) Politicians (kinda)
Poor governance in low-income countries ultimately causes A LOT of global health problems. Poverty becomes exacerbated. Public interventions fail due to corruption. Private markets cannot be efficiently regulated and open the door to exploitation.

Maybe Wycleaf Jean had the right idea on how to help the poor: become a politician.

Admittedly, although many problems are caused by governance, I don’t know that being a non-corrupt, intelligent, or even musically talented politican is the best way to overcome the problem. Bureaucracy, international relations, and other social, political, and economic dimensions discussed in a long list of Yale seminars aren’t easily solved by one Senator’s voice.

But hopefully there will always be people like Nelson Mandella, John Adams, Ellen Johnson Sirleaf and others to prove me wrong.

4) City Planners
There are more people in the world that face obesity than malnutrition. When I first heard that I was amazed. Now, admittedly, it makes sense.

Coined the “obesity epidemic,” a epidemiological transition has led to heart disease, cancer, diabetes, and other BMI-related chronic diseases to (appropriately) take the foreground in Western health policy. (In just about every public health class I have ever taken, obesity is one of the first issues that is discussed).

What can be done to prevent obesity? There are lots of alternative ideas being thrown around: sugar taxes, gym subsidies, improved health education, high quality healthy foods in low-income neighborhoods. All have potential, but one area that needs more emphasis is city planning.

To improve food security, encourage walking, and get people out of the BK breakfast->cubicle->episodes of Lost->bed routine, we need city designers.

In New Haven, I ride my bike or walk everywhere. I have access to nearby healthy foods and a gym. I have groceries delivered to me from a nearby grocery store. (Incidentally, grocery story delivery man could deserve an honorable mention for this list: finally, a way to maybe get produce and fruit to low-income neighborhoods).

By creating cities that can be navigated on foot (with efficient transportation) instead of relying on cars and highways, urban planning can create metropolitan hubs that have improved access to healthy foods while increasing exercise and even decreasing a reliance on (economically- and environmentally-) costly vehicles.

5) Journalists
I like to think I’m an idealist and an optimist. Yet, I get overwhelmed with global problems and discouraged trying to make an actual difference. It is during these times I consider dropping out of school, becoming a Park Ranger, and leading a content life in the wilderness. Or, investment banking.

Despite basically focusing on many of the world’s greatest tragedies, journalists like Nicholas Kristof inspire me and get me back on track. In order to truly address the plethora of public health issues (whether germs, genocide or gender inequality), we need to hear about them. Journalists bring these issues into the spotlight. They inspire. They mobilize. They tell people about the enormous disparity and they recruit the future leaders that will devote their lives to ending them.

Oprah can mobilize a social movement. Ben Franklin used journalism to influence the American Revolution. Glenn Beck can (unfortunately) get millions of people to hang on to his every word. This is a powerful tool to create enormous shifts in our world. Unfortunately, the economic future of journalism remains uncertain so it probably won’t pay that well.

At least there are always blogs.

A Return

September 6, 2010

After an unannounced summer hiatus, Change for a Dollar will be back online later this week.

A New Page on Microfranchise

April 16, 2010

Loyal readers,

I’ve added a new page to the site that includes a working draft of my senior research. The temporary title is:

Social Sector Microfranchising  in the Developing World: Using the Ideas Behind McDonald’s to Deliver Essential Medicines to the Poor

I post a working draft for a few reasons:

1) In the case that there are any readers out there that have interest in this field, perhaps my research could be beneficial to them

2) In the case that there are any critics out there that have feedback, input, or criticism, perhaps they can further enlighten my research

3) By publishing this work publicly, I feel more accountable for my writing. I wonder why open-source writing projects are not found more often on the internet. I, for one, would be very interested in each step of the writing process from leading experts in any field. Likewise, I imagine that a high volume of readers could offer  insight or new ideas to improve any piece of writing.

My thesis includes case studies on the HealthStore Foundation and Living Goods organizations.  They are amazing organizations that are addressing long-standing global health issues with innovative solutions through markets.

AIDS in the Elm City

April 9, 2010

Orginally published on 4/9/10 in the Yale Daily News:

The AIDS crisis is not over. In fact, it’s in our front yard.

Over 6,000 people in the greater New Haven community are currently living with HIV/AIDS. The disease affects every age group, every ethnicity and every sexual orientation. With 15,000 AIDS cases reported in Connecticut in 2007, the state has the ninth highest AIDS case rate per capita. AIDS is not just a global issue; it’s a local problem.

In the nearly three decades since the disease was first diagnosed, progress has been made. We have medicines, research funding and a fundamental understanding of the disease. For those on antiretrovirals, HIV is no longer a death sentence; for those with basic education, HIV is mostly preventable.

Yet even in the United States, stigma persists, discrimination abounds and misinformation continues to lead to unfounded prejudice against homosexuals, drug users and the HIV-positive community. Although HIV currently requires less medical maintenance than other chronic conditions such as diabetes, the social weight of a positive HIV test remains incomparable to other illnesses. Solving the current HIV epidemic in the United States requires more than pharmaceutical drugs, it requires a fundamental shift in how we view HIV and AIDS: a movement to end stigma and increase prevention.

Of course, progress has been made on this front as well. Many cities have needle exchange programs, and in 1998, the Supreme Court ruled it illegal to discriminate based on HIV status. This progress came as the result of a movement that made HIV/AIDS not just a disease but an issue of social justice. The group of people who spurred this movement —who educated the masses, who fought for equality — were not scientists or lawyers or teachers. They were passionate community members that recognized injustice and mobilized to do something about it.

We can continue that movement. Students, with their energy and vast social networks, are best equipped to raise awareness, lobby for change and fight for social justice. Speak up. Support the community. Donate to a cause. Martin Luther King Jr. once said “In the end, we will remember not the words of our enemies, but the silence of our friends.” Don’t be a silent friend.

Every April, hundreds of students and community members unite to hear live music, listen to inspirational speakers and walk through the streets of New Haven to raise awareness for the local HIV epidemic as part of the five-kilometer AIDS Walk. Sponsored by an organization run by Yale student volunteers, the walk has become a symbol of the community coming together to respond to a public health issue, promote individual and community wellness and help those most in need. The proceeds go to nine local charities that provide vital patient services, housing, education, hospice care and prevention projects throughout the city.

By walking together, students can leave a positive impact on the community. In the inspirational words of anthropologist Margaret Mead: “Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has.” Help bring real change to your community, and the world.

Let the AIDS Walk be your first step.

Seeing Social Microfranchising in Action

April 8, 2010

An incredible (and short) article from Entrepreneur magazine that spotlights VisionSpring, a social enterprise that uses a microfranchise business model to distribute eyeglasses to the poor.

Microfranchising the Developing World: Microfranchising helps create a business model for distributing glasses in poor nations.