Health Care

Seeing grocery store in danger of extinction, small-town health clinic steps in

Clockwise from top right: Vista Foods manager Mitchell Johnson, at the cash register, has been teaching NOTCH leaders how the grocery business operates. This 44,000-square-foot former furniture factory in downtown Richford was renovated to house NOTCH headquarters, some of its medical and dental offices, affordable housing, and Vista Foods. In June, NOTCH started operating Vista Foods, a grocery store that was slated to close. It now has 17 employees and 2,400 grocery transactions each week. Pam Parsons, longtime executive director of the Northern Tier Center for Health, holds a sign that hung for decades at a donated home in Richford’s downtown.  Photos by Anne Wallace Allen/VTDigger

RICHFORD — Living 30 miles from the larger hubs of Newport, Morrisville, or St. Albans, Richford residents have often had to travel long distances to reach work, groceries and health care.

A solution to some of the health access problems arrived in 2002 with the establishment of the Northern Tier Center for Health, or NOTCH, a not-for-profit health center that provides family medicine, behavioral health, a pharmacy, a lab, and dental services. The NOTCH serves 15,000 patients per year and operates clinics in several other Franklin County towns.

It’s unusual for a health center to operate a grocery store, said Robert Ostermeyer, director of Franklin/Grand Isle Community Action. But it fits into recent thinking about using community solutions for wellness.

“It is really, really remarkable on their part,” he said. “It speaks to the depth of need for a market in that area, as well as their commitment to begin to act as agents to influence community health in a very different way.”

Decades ago, health providers started taking wellness seriously as a way to reduce costs and improve overall health and quality of life. The move started with things like exercise promotion and stop-smoking classes. 

And in June, after the owner of the town’s only grocery store announced it would be closing, the NOTCH stepped into a new role.

Now the leaders of the nonprofit health center are learning about the grocery trade as the NOTCH operates a full-size grocery store, Vista Foods, in its building.

State and federal programs like the Vermont Blueprint for Health look for community-based solutions to escalating health care costs, such as investing in social determinants like housing and food security.

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Blueprint for Health provides money to federally qualified health centers to help patients with transportation, nutrition and fitness classes, and other aspects of healthy living.

“It might be something as simple as a bathing suit to get in the pool,” said Beth Tanzman, executive director of the Blueprint for Health program. “Research confirms that helping people with weight management has a direct connection to their health and wellbeing and health care costs.”

A project built on a shaky past

Richford has long struggled with higher-than-average poverty rates, lower incomes, lower home values, lower educational attainment and other indicators. The town, located on the Canadian border, has a population of about 1,600, and 15% of residents live below the poverty line, according to the U.S. Census. The Census says per capita annual income in Richford was about $20,000 in 2018, about half the number for the Burlington-South Burlington metro area, and about three-fifths of the $33,238 Vermont per capita.

Richford residents started trying more than half a century ago to attract a doctor to town. In the 1960s, the town fixed up a donated downtown home to house the clinic. A Help Wanted sign hung on the house for years.

“A couple of Canadian doctors came down; doctors came and went,” said Pam Parsons, now executive director of the NOTCH. “Nothing stuck.”

The town also recently lost its only remaining bank when TD Bank moved out, said Parsons, and the historic brick bank building is now on sale for $225,000.

Parsons, an Enosburg native, started out on the board of the Richford Health Center and became its leader in 2000. With others, she secured funding to create a federally qualified health center in 2002 in an old house. FQHCs receive federal money to provide primary care services in underserved areas; Vermont has several of them.

A half-dozen years later, the organizers secured federal, state and local support to renovate a 44,000-square-foot former furniture factory in downtown Richford and move the clinic — by then renamed NOTCH — there in 2007. The third floor is occupied by affordable housing.

At that time, Richford had no full-size grocery store, although there were smaller stores in town where residents could buy staples. The NOTCH organizers were focused then on adding more medical services, such as a dental clinic that went into the building’s fourth floor.

But they knew that creating a source of affordable groceries, including fresh fruit and vegetables, was critical to their health mission. With nearly no public transportation to rely on, said Ostermeyer, residents don’t have a good way to reach larger stores in places like St. Albans.  

“If you are living on a limited income, you don’t have access to transportation, you are really kind of stuck,” he said. “You have to bum a ride with a neighbor or wait til a relative is going to town.”

A private owner opened a store in the Notch building after 2007, but went out of business. A second managed to stay open for 10 years. When he decided to stop, his distributor, Associated Grocers, had recently decided to make a foray into retail, and stepped in in 2017. Associated Grocers operated it for three years.

“They did a wonderful job,” said Parsons.

But a corporate change at the New Hampshire-based Associated Grocers put the store in peril once again. AG announced it would close Vista Foods in March, leaving Richford customers who didn’t have reliable transportation with the choice of two gas-station convenience stores and a Dollar Store as their food shopping options. 

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Parsons doesn’t bear any ill will toward Associated Grocers for its decision. She said the company worked closely with the NOTCH to help come up with a way to keep the store open.

“Through this whole process, they have been great partners in giving us good guidance and direction and help,” she said. “Associated Grocers said, ‘We’re not going to let you fail; call us.’”

Finding partners

To take ownership of the business, Parsons and others reached out to Ben Doyle, then at the USDA and now the recently appointed head of the Preservation Trust of Vermont, and also contacted the Northern Border Regional Commission (which came through with a $175,000 grant in August); the Vermont Farm to Plate program; the Vermont Sustainable Jobs Fund, local officials in Richford, and the Working Lands Enterprise Board. The group met in February in the NOTCH’s fourth-floor conference room, which includes a kitchen for community cooking classes, to chart a course forward.

The group knew that, without Vista Foods, Richford could become a food desert, a term social scientists use to describe a place where residents don’t have ready access to healthy, affordable food choices. While many people associate the term with an urban neighborhood, rural places in Vermont can also become food deserts if they don’t have the small grocery stores, food co-ops, general stores, and other small retailers that are accessible to people who live in small towns and lack transportation.

“Smaller retailers, like what is happening with this nonprofit grocery store, are really important and they provide opportunities for a retailer to be focused on community-driven priorities, rather than just financial priorities,” said Faye Mack, advocacy and education director for Hunger Free Vermont. 

Food access is a national problem, according to the Vermont Natural Resources Council, with 23.5 million people in low-income areas nationally living at least a mile from a supermarket or large grocery store. The council said convenience stores charge as much as 76 percent more than grocery stores for basic foods and rarely stock fresh fruits and vegetables.

The organizers were also concerned that, with the closure of Vista Foods, 17 employees were in imminent danger of losing their jobs.

Ultimately, the NOTCH board and its supporters persuaded Associated Grocers to wait until the end of June to close, and then the nonprofit health center, which has a community board, took over, retaining the original manager and staff. Parsons said a few other community health centers in the U.S. also operate grocery stores and markets.

It’s not yet clear if the store will make money; Parsons said the margins are slim, and the Canadians who made up a large proportion of customers at many Richford businesses have been kept out by the Covid-related border closure. But it’s close to breaking even now. Any profits will go toward improving wages and benefits, she said. 

About 2,400 grocery transactions take place at Vista Foods each week. Parsons said NOTCH couldn’t have taken over the operation if it hadn’t been for the staff who knew how the system works, such as manager Mitchell Johnson.

“This doesn’t happen unless you have got strong employees who have worked in the business and can operate it day-to-day,” she said. Johnson, who has been with the store through two previous owners, “has been willing to teach us and help us along the way to understand how the facility operates.”

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Anne Wallace Allen

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