The 'Side Effects' of Good Intentions

Phys Ed Plus (PEP) was founded in 2010 by Brian Semonian a certified physical educator. PEP is a non-profit whose mission is to bring comprehensive Physical Education programs to elementary schools that do not have them. Their programs align the needs of the school (schedule, funds, space access, and coordinated use of parks) and community with the main objective of teaching kids the capabilities needed to develop and maintain healthy habits. PEP works with schools throughout the five boroughs providing resources such as certified physical education instructors. In 2011, PEP was working with a school in East Harlem. Due to constraints mentioned, there was only one physical education period per week and with over 60 children per physical education class. PEP provided an additional instructor to assist the current staff and then worked with the school on programming. Together they introduced an after-school soccer for kids and a morning adult Zumba program. Brian believed that the Zumba class would increase parental involvement and punctuality by targeting and enticing late comers with first access to the Zumba classes. The classes were very popular with strong and timely attendance. But there was an interesting "side effect," student tardiness decreased. The punctually trend paralleled the popularity of the morning Zumba program. The program which started in 2011 continued through 2014.

Then there are times, frequently in public policy, when no effect is de facto an adverse effect. A recent article in the New York Times Upshot Section, "Giving The Poor Easy Access To Healthy Food Doesn't Mean They Will Buy It" examined the effectiveness of programs designed to address food deserts. The US Department of Agriculture defines food deserts "as urban neighborhoods and rural towns without ready access to fresh, healthy, and affordable food. Instead of supermarkets and grocery stores, these communities may have no food access or are served only by fast food restaurants and convenience stores that offer few healthy, affordable food options." The USDA's Economic Research Service estimates that 23.5 million people live in food deserts with more than half of those people (13.5 million) are low-income. The lack of access contributes to a poor diet and can lead to higher levels of obesity and other diet-related diseases, such as diabetes and heart disease.

In the aforementioned article a study by the National Bureau of Economic Research, "What Drives Nutritional Disparities? Retail Access and Food Purchases Across the Socioeconomic Spectrum" was referenced. The results of the study showed that "more educated households purchased more healthful foods." Also in instances where there were new stores introduced or changes in existing stores product offerings were enhanced to provide healthier choices, purchasing patterns showed little change in households with low levels of income and education. It's clear from the study that in addressing the issue of access is a fundamental first step but that merely access doesn't induce behavior change. If determinants of more healthful purchasing decisions are higher economic and education levels what can be done in the short term? One approach would be to educate the purchasing decision makers and influencers. The introduction of nutrition classes and health education with the new product offerings or the introduction of stores to food deserts. Parents and children need to be equipped to make healthy choices. First they need to know that with new stores healthy choices exist (not just more bodegas) for their prevailing buying habits and cooking routines. Programs like these and any effective education initiative require organization and ongoing commitment, access is just the initial hurdle whether it is healthful foods or quality education.

Consequences (and lack thereof) are opportunities for learning and improvement. In medicine, side effects are unintended and unknown effects and come to light only after a treatment is administered. While side effects are commonly thought of as adverse or harmful, side effects can be beneficial. When they are beneficial the side effect often becomes the primary intervention and programmatically an intended outcome. In both instances it's worth remembering that side effects are not always adverse and can be fascinating stories of innovation and discovery but that upon discovering what the side effects are taking advantage of those opportunities requires a continuous or completely new type of commitment.