The Home Grown Institute
sustainable and
Regenerative Skills
The headline reads "Access to Grocers Doesn't Improve Diets, Study Finds" in today’s LA Times. While Daniela Hernandez’ article citing a 15 year study tracking thousands of people might feel like a blow to the many hours and initiatives people have devoted to increasing access to fresh food, I want to shout “Wait! Don’t despair – It isn't that access doesn't work, it just that access alone doesn't work.” Access is just one piece of the puzzle and although not everyone knows it, this puzzle has already been solved.

A long time ago, as an undergraduate at The Wharton School, I did my senior research project in the Leonard Davis Institute of Healthcare Administration. With Dr. John Hershey in the lead, we were analyzing data for a study in what was then the newly emerging field of "Compliance With Therapeutic Regimens." In this case we were looking at what factors helped people make it a habit to take their hypertensive medication. Thirty years later, in the more mature field of study now called "Adherence" which still asks the question "what helps people succeed in making healthy change" guess what we find?  Every study* since we began to ask the question has identified the same three and a half factors that lead to success. Every study! Even though Thomas Edison famously speculated that as humans, "we don't know one millionth of one percent about anything," maybe we do know at least a little something about what helps us make and stick with healthy change. 

Without further delay, the three factors are:
•	Intrinsic Motivation ‐ You gotta wanna do it. Not because your mother said so, or your doctor said so, or the article in the NYT said so, but because you really, deeply know you want it for yourself.
•	Access to Resources ‐ It ain’t gonna happen unless the ways and means needed are available and the obstacles to access are removed. Time, money, products, services, valid and valuable information, convenience and a reasonable, do‐able, plan of action are the foundation.
•	Social Support ‐ A companion, or buddy can make the difference between action and inaction. Even just a witness or someone you ask to hold you accountable bolsters this factor.
•	The Half: If there is a Provider of a Service, a good relationship with that provider can make a big difference.

The research goes on to say that the likelihood of success is not so high when only one of these factors is present, but that the likelihood of success skyrockets when all three and half of these factors are in place. This is the problem with "access" as the answer. It is only a piece of the answer. 

Motivation is a big part of the solution. Research tells us that the two biggest motivators are pain and pleasure, with the mitigation of pain the stronger of the two. Access is big part of the solution. Organizations such as The Food Trust and The Fresh Food Financing Initiative should be applauded for the progress they have made increasing the availability and affordability of fresh foods. But simply a "build it and they will come" (provide it and they will eat) strategy is not enough. While access can be a challenge it is not the biggest challenge. 

We can look at the food system as comprised of three components: production, distribution and consumption. It is this last component of consumption - what people actually put in their mouths - that is the final test of the system working. We can grow it locally, organically and sustainability. We can sell it in healthy carts and corner stores, farmer markets and grocery stores. We can even teach it and regulate it. But even then, even those of us who are strongly motivated and who have access to loads of resources still do not always make healthy choices. No, it's not motivation or access that is our biggest challenge. It is the final piece of the puzzle that in the end helps us the most: our systems of social support.

So many people really want to make healthier choices. Many of them even know the fundamentals of what that means - more fruit and vegetables, less junk food - and while there is still plenty more work to be done on issues of access (availability, affordability and education), that final test - what goes from shelf to fork to mouth when the belly or brain or clock says "food" - may be more influenced by social than anything else.

But with the pace of life trying to keep up with the speed of technology, as Harvard sociologist Robert Putnam reported to us in his landmark book Bowling Alone, one of the things that has been most affected in the last 50 years is our social communities. This then is our challenge.

So, those of you who have been working so diligently to provide access, do not be discouraged, but do look beyond your piece of the puzzle and begin to focus some of your resources to the question of social support. The solution to our health problem is right in front of us - or maybe next door to us. We need to use all the pieces of the puzzle to make the change happen. 

Stay tuned for Part 2, where we'll analyze social support, breaking it down into its three roles of witnessing, accountability and companioning. We'll also talk about "the half."

Sarah Gabriel an author and is the managing Director at The Home Grown Institute – organizing community-centered, skills-focused, action driven events that teach home-scaled sustainable and regenerative practices. Visit for more information.


John C. Hershey, PhD, Bruce G. Morton, EdD, Jane Braithwaite Davis, RN, and Michael J. Reichgott, MD, PhD, “Patient Compliance with Antihypertensive Medication,” American Journal of Public Health 1980; 70:1081-1089.

E. Vermeire MD, H. Hearnshaw* PhD BSc MA, P. Van Royen MD PhD and J. Denekens MD PhD, “Patient Adherence to Treatment: Three Decades of Research. A Comprehensive Review,” Journal of Clinical Pharmacy and Therapeutics (2001) 26, 331±34.

Putnam, Robert D, Bowling Alone: The Collapse and Revival of American Community, New York: Simon & Schuster, New Ed edition August 7, 2001.

Gabriel, Sarah, Unexpected Initmacy: Everyday Connections that Nourish the Soul, Denver: Great Room Press, 2nd ed. 2009.

Photo credit - Farm to City’s Rittenhouse Square Farmers’Market
How to Fix our Diets - The Puzzle is Solved, Part 1
Sunday, July 17, 2011