Ethnic Health

As the nation moves into implementing health care reform, supermarkets are concentrating on a strong health and wellness platform that links food consumption to good health as well as a host of other health-oriented services.

The diversity among today's shoppers, however, presents its own set of challenges when it comes to marketing health and wellness to minorities who are underserved in health care.

Statistics from the U.S. Department of Health and Human Services illustrate the health disparities among demographic groups. For example, African Americans are 15% more likely to suffer from obesity than whites. They are more likely to die from cancer than any other racial or ethnic groups. They are 15% more likely to suffer from adult-onset diabetes and they experience HIV infections at seven times the rate of whites.

Barriers to what is often referred to as health equity among multicultural populations are many, including socio-economic conditions and lack of access to health care providers because of being uninsured or underinsured. Language, education and cultural barriers add to the complexity of delivering health and wellness to diverse groups.

The role that culture and assimilation play in good health is revealed when examining Asian Americans who, due to their cultural orientation, generally pursue a healthy lifestyle when it comes to food consumption. Recognizing the importance nutrition plays in health, Asian Americans go out of their way to buy fresh produce. They strive to achieve the proper balance between mind and body. Physical activity and exercise — yoga, tai chi, stretching, walking, meditation, chi gong and martial arts — are viewed as equally important as good nutrition in maintaining overall health. Foreign-born Asians view exercise for its holistic benefits such as improved blood circulation and movement of ‘chi’ energy rather than for cardiovascular health or body sculpting. However, acculturation begins to change Asian Americans' good dietary habits and ultimately negatively affects their health. Chinese Americans have higher rates of chronic diseases than Chinese in Asia. This is attributed partly to differences in dietary patterns, according to the Journal of the American Dietetic Association.

In California, research indicates the percentage of low-income Asian and Pacific Islander children who are overweight more than doubled between 1994 and 2003, from 7% to 15%. This was attributed to poor diet and sedentary lifestyle.

These statistics as well as other factors that impact the health of African Americans and Hispanics will be presented tomorrow during a workshop entitled “Building Health & Wellness Through Ethnic Marketing.” Thomas Tseng, principal and co-founder, New American Dimensions, Los Angeles, will conduct the presentation that is part of the Health and Wellness Conference of the 2010 FMI Show.

In his presentation, Tseng discusses the health disparities ethnic minorities face and their culturally based beliefs and approaches to health care. In describing the challenges ethnic populations face in staying healthy, Tseng cites statistics from numerous sources. Some insights include:

• Less acculturated Latinos trust home remedies and natural treatments over prescription drugs.

• Immigrant Hispanics take a reactive approach to health care.

• Of all immigrant racial/ethnic groups, Hispanics have the lowest rates of health insurance. Of Hispanics under the age of 65, 34% lack health insurance.

• African Americans suffer from a high incidence of chronic diseases (hypertension, type II diabetes, heart disease and several types of cancer) that can be traced to an unhealthy diet.

• Half of all U.S. cases of HIV are African American.

• African American females self-medicate and “wait it out.” Some avoid medicines and opt for alternative treatments and home remedies.

ETHNIC HEALTH CHALLENGE

What role supermarkets can play in serving the health needs of minorities is not nearly as well defined or conceived as retailers' ethnic food marketing initiatives. Food retailers have years of experience developing food merchandising and formats designed to satisfy — to varying degrees of success — ethnic shoppers' cultural orientation. But when it comes to marketing health and wellness products and services to disparate groups of people, supermarkets could find the challenge of cultural idiosyncrasies insurmountable within a retail box meant to serve everyone.

Tseng calls this the middle ground dilemma.

“Supermarkets and other mainstream retailers won't be able to legitimately reach ethnic consumers via health and wellness programs without ceding this middle ground. If they were to completely renovate their product assortment and formats to tailor completely to an ethnic consumer segment — competing with botanicas, herbal stores and the like — they sacrifice something else.

“Hence, the challenge will be to figure out how to maintain a delicate balancing act — how to cater to ethnic consumers, but do it in a way that positions their offerings more effectively and without completely reconfiguring their product assortment mix. After all, we already know that Hispanics — to cite one group — shop at significantly more retail channels in contrast to the general market. So how do you optimize your share of their spending?” Tseng asks.

He warned mainstream supermarkets risk alienating their core shopper base if they move too far from the middle ground to appeal to ethnic shoppers. Care should even be taken in using bilingual signage, Tseng noted. “There is that cost plus risk benefit you have to think about in engagement.”

Supermarkets, particularly supermarket pharmacies, are gearing up to be a player in health care reform as the nation begins to implement recently passed legislation.

“Thirty million more people will be in the health care system by 2014, and there are not enough doctors to take care of everybody. We need to find ways to reach customers, and if we empower them with tools to take care of their own health, we think we will ultimately reduce health care costs and can focus on wellness and prevention,” said Bart Foster, chief executive officer of Atlanta-based SoloHealth, a technology company that has developed a self-assessment eye care kiosk (see “Serving the Underserved”).

With their growth in numbers, ethnic shoppers will be an important constituent for supermarkets in health care outreach. Their numbers are projected to continue to grow, albeit at a somewhat slower rate given the focus on immigration reform.

In a recently release Packaged Facts report, entitled “Ethnic Hair, Beauty and Cosmetics Products in the U.S.,” the researchers point to U.S. Census Bureau figures that put the number of resident ethnics at 109.4 million in 2010, and project their population will swell by over 9% to 119.7 million in 2014. The collective minorities will eclipse mainstream whites as early as 2042. As of that milestone, ethnics will collectively become the mainstream, and whites will become the single largest minority.

RETAILER OPPORTUNITIES

So the opportunity abounds for supermarkets to get their fair share of ethnic health care spending. While the strategies on how to do this have yet to be defined, the general consensus among retailers is that they see value in outreach and addedservices.

Mike Juergemeyer, vice president of fuel and pharmacy for Schnuck Markets, St. Louis, says free antibiotics and prenatal vitamins and the chain's $4 and $10 generic drug program make it easier for those with low incomes and fewer discretionary dollars to get medications.

“We strive to service all communities and people in all socio-ethnic backgrounds. The more relevant we are to our shoppers, the better we can service them. On the pharmacy side, it is pretty much determined by what the doctor prescribes,” he said.

Save-A-Lot in Oak Cliff, Texas, has shown its commitment to the Hispanic community by hosting an event focused on the health of Hispanic children who are at greater risk of developing health problems associated with being overweight. The goal was to provide information and resources that many Hispanics might not be aware of due to a language barrier, or because they are new to the country, said Andrea Wagner, vice president of fresh for the Save-A-Lot store.

Maria Brous, spokeswoman for Publix Super Markets, Lakeland, Fla., says the retailer, which merchandises to its heavily Hispanic shopper base through its Sabor banner, has not targeted a specific ethnic group with health care. However, she points to Publix's launch earlier this year of the first phase of a new diabetes management system and distribution of free diabetes medication metformin in generic form.

“Our diabetes program is important to certain populations. African Americans and Hispanics both have a high prevalence of diabetes, so we've marketed more information to African American newspapers, for example,” she told SN.

John Fegan, vice president of pharmacy for Winn-Dixie Stores, Jacksonville, Fla., said the retailer offers a variety of products and programs designed to help customers maintain a healthy lifestyle.

“We hold quarterly health testing events and immunization programs, and we also host nutrition tours to educate our customers on healthy behaviors. In addition, we have partnered with the Public Health Department to make oral influenza medications available at little or no cost to the customers in need of assistance,” he sold SN.

In April, Winn-Dixie introduced a new translation feature to its online WD RxConnect, the retailer's centralized prescription record system. The service helps Winn-Dixie pharmacists overcome language barriers so they can effectively complete transactions and consultations with customers. Translations are available in more than 1,000 different languages.

Tseng said supermarkets should focus on what they do credibly.

“Supermarkets can do a considerably better job at developing a relationship with their ethnic communities. Many ethnic shoppers are already going to their local supermarkets, but do they feel a strong affinity for the supermarket in the same way they do as a local mercado, bodega, panaderia or a botanica? Probably not. And supermarkets have not helped their cause to gain a greater share of their spending,” he said.

He recommends community outreach programs, local staffing, ensuring in-language communications and loyalty programs — all of which help to build a sense of connection to the store.

The Packaged Facts report points out the trickiness involved in navigating the diversity of sectors and the dynamic between two separate sales approaches. “Hispanic and Asian cultures each feature many dialects, and some wholly different languages; therefore, targeting the growing ethnic sectors is not just a matter of scale, but also of micro-marketing to more subsectors, unless one chooses to target those Hispanics and Asians who have been assimilated into U.S. society. And regarding how ethnics spend their HBC money, they spend much more on general-market products than on ethnic-specific products,” the report stated.

But Tseng noted that ethnic consumers do not automatically reflect the general market with acculturation. “Through acculturation, ethnic consumers continue to traverse through two worlds (the old one and the new one), but with a greater openness toward the American mainstream. Supermarkets can effectively speak to the aspirations of these shoppers — but also use cultural cues and tropes that are familiar to acculturated ethnic shoppers — to their advantage.”

Perhaps the best way for supermarkets to aid their ethnic shoppers is to make sure they have grocery stores that sell fresh produce and food located in underserved urban markets. Access to such stores has been proven to favorably impact the health of those ethnic populations living in the community.

WHAT IS HEALTH?

Health is defined differently by the three major ethnic groups, according to New American Dimensions data.