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Health, Science, Environment

Mothers find state WIC rules create obstacles to getting nutritious foods

graphic about monthly WIC food supplements
Alex Sciuto | St. Louis Beacon 2010
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This article first appeared in the St. louis Beacon: The low-rise building at Cass Avenue and 14th Street is now a used-car lot, but many neighborhood residents still remember it as Salama, a corner grocery. It stocked some nutritious foods and infant formula as part of the federal government's WIC (Women, Infants and Children) program to help disadvantaged residents raise healthy young children.

About four years ago, federal officials accused the store and a half dozen other corner markets of mismanaging WIC and removed them from the list of approved vendors.

This well-meaning decision had an unintended consequence. It meant that hundreds of needy mothers and children, many of whom did not own cars, no longer had access to convenient places within their zip codes to buy the protein-rich food supplements under WIC. Salama was across the street from the O'Fallon Place Apartments, which serves low- to middle-income tenants who used the grocery after a nearby full-service supermarket closed.

The federal actions against the corner groceries had far-reaching consequences. Replacing them with other corner store merchants has been impossible because Missouri's rules have changed. The state now requires that WIC products be available exclusively in full-service supermarkets, which are rare in most poor neighborhoods. Not all states have this requirement.

Items that the state requires all stores to stock include cold and hot cereals, fruit juices, milk, soy milk, cheese, eggs, dry beans and peas, peanut butter, meats, fruits and vegetables for infants, along with fresh and frozen fruits and vegetables.

Carolyn Dickerson, a mother in her 20s, had been among Salama's loyal customers. Thanks to help from the highly regarded Maternal, Child and Family Health Coalition, Dickerson learned early to turn life's lemons into lemonade. The shutdown of Salama probably became a disincentive for some who didn't want to bother with the inconvenience of taking buses across town to find a supermarket that sold nutritious foods. But not Dickerson, then pregnant with her first and only child, now 4.

"I did what I had to do," she says. "I was determined not to let my condition prevent me from reaching my goals."

Food packages vary based on the child's age and whether the mother chooses to breastfeed. See the USDA for more information on food packages. See the Missouri Department of Health and Senior Services for what foods are allowed or prohibited for purchase with WIC funds.

Still, she was not exactly happy about losing access to WIC products at Salama.

"Yeah, I was kind of mad," she said. "When it was cold, I could handle that. But the snow made it harder for me. Unless I had a ride, it meant taking the baby back and forth on the bus to get food."

Fewer Chances to Make Good Choices

The loss of access to nutritious foods on the north side is an example of public policy failing to keep pace with new thinking about the health-related causes and consequences of living in poor neighborhoods. Policy makers are learning that illnesses and poor health aren't simply the result of people making bad choices. They are finding that people living in many urban neighborhoods have fewer chances to make good choices.

Cheryl Kelly, an assistant professor at St. Louis University's School of Public Health, did not have WIC in mind when she commented on giving people the options to make healthy choices. But her thoughts apply just as well to WIC products.

Kelly's research has documented locations where it's hard to find nutritious foods. Her work has also spotlighted areas with poorly maintained sidewalks and parks in parts of St. Louis and St. Louis County. She suggests that people's attitudes about healthy eating and regular exercise are influenced by these factors.

"At the end of the day, people will make the choices they want to make," she says. "They may choose to smoke or go to McDonald's or sit on the couch and watch TV. But if we make it easier for people to get fruits and vegetables to eat, make parks safer for exercise, people may be more likely to do those things."

She says public policy should focus on building "the most ideal environment to support people making healthy choices."

If a child lacked convenient access to food assistance given away by the federal government, the thinking used to be that the onus fell on the family to figure out a way to get to alternative food sites. That meant poor people were expected to show the kind of grit that made Dickerson rise on cold, snowy mornings or hot summer days to catch a bus to a grocery store even if it were halfway across town.

Of course, people who live in better neighborhoods don't have to summon much determination at all. They can take it for granted that a well-stocked grocery is nearby, and they don't have to rely on public transportation to get there.

Public health practitioners in particular have begun calling attention to a possible connection between health outcomes and convenient access to healthy foods, including WIC products, that can lead to healthier pregnancies and births. The access not only contributes to a healthier newborn, but it can help avoid later hospital and medical costs associated with problem pregnancies and sick children. It not only helps the families involved, but those in the suburbs who pay taxes to support a broken health-care system.

Five Thousand Families with Little Access to Supermarkets

The absence of decent supermarkets to buy WIC-approved foods is acute on the north side among mothers with fewer than 12 years of schooling. Many don't bother to get any prenatal care during the crucial first trimester of pregnancy. Many of them live in neighborhoods and zip codes where full-service grocers with WIC products are less plentiful or nonexistent.

According to state data, the northern end of the city is perhaps the most underserved in terms of access to full-service supermarkets. Nearly 5,000 families served by WIC live in that part of town, but they can count only seven stores where needy mothers can buy WIC supplies.

On the other hand, there is no shortage of stores offering less healthy foods. The dilemma is summed up by two billboards that stood side-by-side during part of the summer at North Florissant and Chambers Street. One featured two wholesome-looking infants and messages suggesting that every low-income mom could give birth to babies like these if she took part in the WIC program. The other billboard promoted a sugary soft drink with the slogan, "There's nothing like a Pepper."

Of course, you can buy a Dr. Pepper practically anywhere. But that's not the case for WIC-approved foods. Missouri seems to have taken an all-or-nothing approach to WIC foods. A grocer must carry them all, or it cannot participate in the program.

Randy J. Walton, the state's WIC vendor coordinator, says he wishes WIC outlets were more plentiful. The Missouri WIC program, he says, constantly looks for additional vendors.

Walton also notes that state policies are governed for the most part by federal rules. He was asked about the possibility of dispensing WIC products at community health centers, churches, food pantries and other unconventional locations to make the products more accessible to needy women.

"Local health centers are not set up to stock and sell WIC foods," he says. "Only a full service grocery can provide all the approved WIC food items."

In some instances, he says the stores removed from the WIC-approved list were decertified for shortcomings ranging from failing to carry all the required WIC products to fraud. He didn't comment specifically on the Salama case except to say, "I can tell you that (the charges) were serious."

He added that the merchant was disqualified for three years and had the option to reapply, provided the market met all changes in the new qualifications. Salama would not have met them because it is not a full-service supermarket.

"WIC participants must be able to get all of the WIC food items listed on their WIC checks at any WIC approved store," Walton says.

Asked who made this policy that, in effect, limits WIC to full-service supermarkets, Walton said that policy resulted from "careful consideration of the program costs and the needs of the participants." The goal, he said, was to make all these WIC-approved foods available at a single location so participants wouldn't have to travel to several stores to get them.

When merchants are taken off the WIC list, Walton says state officials review all WIC-approved stores in the immediate area and the distances moms might have to travel to get food. The state, he says, wants to make sure other stores can meet the needs of WIC participants. He provided no specifics about the allegations against stores that have been decertified, but he said it would be unfair to allow any store that committed violations to remain in the program.

Neighborhood Grocery Thrives Without Wic

Khaled Salemeh, owner of the old Salama food market, said he had been a WIC vendor for 15 years before the state's action.

"They said we didn't keep enough stuff," he says. "Not true, not true. I'm providing every service the big guys (major supermarkets) are providing, from clothing, to hair products, beverages and groceries."

He alleges that the crackdown was aimed at putting small merchants out of business, a notion that Walton strongly denies.

Oddly, the loss of the opportunity to sell WIC products hasn't hurt Salemeh's business. He vacated the old store at 14th and Cass and moved to a new facility at 1513 North 13th Street. There he has opened a new collection of stores, called Salama Crown. It's a block long business, including food, package liquor, a beauty supply store and a sporting goods store.

On most days, he occupies a glass office, working a calculator and monitoring activity inside the food mart. On a recent Sunday, the store was doing plenty of business from people buying gas at the Mobil pumps outside and treating themselves to snack food, a small selection of fruits and vegetables, and fried chicken and other items served in its deli section.

Salameh employs several clerks, and the complex is nicely landscaped with a low level black fence surrounding the oblong building. On one end, next to the car wash, stand rose bushes still blooming on a breezy Sunday afternoon.

"I have 20 years of experience, and I'd like get back into the WIC program," he says. "Now look what has happened, the big guys have left and we're the only store willing to stay and serve people."

Salameh has a business that seems to have many of the items most of his customers want. What's missing is a large supply of fresh fruits, vegetables, meats and beans. And a WIC license that's now provided only to full-service supermarkets.

This story was written with the assistance of the Dennis A. Hunt Fund for Health Journalism, which is administered by the California Endowment Health Journalism Fellowships, a program of USC's Annenberg School for Communication and Journalism. Funding for health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization whose vision is to improve the health of the people in the communities it serves.

World's Apart

This article is the third in a series that examines health-care disparities that persist in the St. Louis area, despite the fact that the region is blessed with some of the finest medical facilities in the world.

Where we live can determine how long we live

St. Louis struggles with its promise to care for the poor

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