Say “Food desert” if you mean “Inequitable Access”

3

October 6, 2012 by yuiweng

Food desert, a simple and memorable term, successfully caught the attention to policy makers, public medias, funders and academic.  It may not be that of a huge success if the researchers use “inequitable access” at the beginning. In both urban and rural areas, food desert are all over US. It usually locates at low-income area, and sometimes ironically in places that used to grow food. At Wake County, North Carolina, 10 food deserts are identified because of limited physical (distant and public transportation to grocery stores) and financial (a poverty rate of 20 percent or higher) accesses. It is worth noticing that many local farms and also the North Carolina State farmers market are within the food desert area; meaning that the sources of fresh produce is not of a big problem but the distribution of these locally grown fruits and vegetables.

Even though lacking healthy food access seems to be a reasonable explanation for low fruits and vegetable consumption, the question is, does better access to health food really increase fruits and vegetable intakes?   From the literature review conducted by two nonprofit organizations: PolicyLinks and The Food Trust. “The Grocery Gap: Who Has Access to Healthy Food and Why Does it Matters” shows that eight studies analyzed access to nearby supermarkets or large grocery stores that sell a wide variety of healthy foods in relation to consumption of fruits and vegetables, specific healthy foods (such as low-fat milk or high-fiber bread), or a healthy diet (measured by an index of diet quality). Almost all of these studies control for individual characteristics such as race and income and still find a relationship between access and healthy eating.

Now that we know healthy food access does relates to healthy eating habits, the next question is, does increase access to healthy food really promotes better health outcome at low-income population? In Indianapolis, BMI values correspond with access to supermarkets and fast food restaurants. Researchers estimate that adding a new grocery store to a high-poverty neighborhood translates into a three pound weight decrease, and eliminating a fast food restaurant from a fast food dense neighborhood translates into a one pound decrease. (1) In California, obesity and diabetes rates are 20 percent higher for those living in the least healthy “food environments,” controlling for household income, race/ethnicity, age, gender, and physical activity levels. A 2009 study of Chicago’s food deserts found that as the distance to the nearest grocer increases relative to the distance to the nearest fringe food outlet, the Years of Potential Life Loss (YPLL) due to diseases such as cancer, cardiovascular disease, diabetes, and liver disease increases. This relationship is significant in African American communities, but less clear for white and Hispanic communities. (2)

As these and many other studies suggested, many residents of low-income, minority and rural communities lack sufficient opportunities to buy healthy and affordable food. On the other hand, they have higher access to fast food restaurants and corner stores with high calorie and long shelf life food. Food desert can be a great tool for researchers and politic makers to locate the communities in need. However, other factors that influence what people buy and eat, like food prices, preparation time and knowledge, marketing, general levels of education, transportation, cultural practices and taste, also play important roles in people’s diet and health.

Reference:

(1)    Liu, G., Wilson, J., Qi, R., and Ying, J. “Green Neighborhoods, Food Retail and Childhood Overweight: Differences by Population Density.” American Journal of Health Promotion 21, no.4 (2007): 317-325.

(2)    Gallagher, M. The Chicago Food Desert Report. Chicago, IL: Mari Gallagher Research and Consulting Group, 2009. Available at http://www.marigallagher.com.

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3 thoughts on “Say “Food desert” if you mean “Inequitable Access”

  1. Sarah S. says:

    It definitely makes sense to me that the existence of food deserts and/or food swamps could be good indicators of places where citizens are at higher risk of overweight/obesity and therefore at higher risk of adverse health outcomes. The research you references definitely seems to suggest that this is the case.
    In doing some other reading on food deserts and food swamps, I came across this article from the NY Times (http://www.nytimes.com/2012/04/18/health/research/pairing-of-food-deserts-and-obesity-challenged-in-studies.html?_r=0) that cited two different studies claiming that these relationships between healthy food access, food choices, and weight were not as strong as everyone has been claiming. (I couldn’t actually read the studies without paying lots of money…) The Economist also had a similar interesting article (http://www.economist.com/node/18929190). If these relationships aren’t a strong as once believed, I think the issue lies in the factors that you listed in your last sentence: food prices, preparation time and knowledge, marketing, general levels of education, transportation, cultural practices and taste.
    While these issues are really complex, I believe that the increased efforts and support of SNAP-Ed are one example of ways that we, as nutrition professionals, can work to improve the strength of the relationship between better access of healthier foods and actual increases in healthy food consumption. If consumers don’t have proper knowledge of what the healthier foods are and how to prepare them, increasing access won’t help. So, while we work to increase access to healthy foods I think a great deal of effort should also be put toward decreasing all of the other barriers that might keep people from eating the healthier options that become available.

  2. hkari2012 says:

    There are so many factors that feed into dietary choices–like household income, race/ethnicity, age, gender, physical activity–that I find myself being skeptical of research that controls for all of these factors. Granted, quality research isolates a causal factor by controlling for these confounders but we know that in the real world it is the interplay of all these social and personal factors that lead to dietary choices. It is not just the distance to the grocer but also the household income that limits transportation options and perhaps even the historical housing segregation and redlining that occurred in metropolitian centers in the South.
    This also makes me think of the article Laura S shared with us this past summer about the Whiteness of the Food Movement. Eating locally grown,organic foods and eating healthy foods has become a gentrified process that once again makes the ideal dietary habits attainable for those with enough income and over-represented by whites. Having a garden has become part of the white consciousness of ethical eating and making healthy eating an moral right. Food access is inherently racialized because minorities disproportionately experience food insecurity; so yes, when I think “food access” I think “inequitable access”.

  3. jsohl says:

    The increased risk of overweight and obesity for low-income people living in food deserts is certainly unsettling. The lack of healthy choices available to them certainly comes into play and should be addressed, but other factors play into this paradox as well (1). The lack of flexibility in their schedules and limited education may also contribute to higher risk of overweight and obesity in this group (2). Some may argue, and I would agree, that these factors lead to a greater need to increase access to healthy foods. Public health efforts should also focus on education (as is the case with SNAP-Ed), but exposing those living in a food desert to healthy foods should be the first step in encouraging a diet that may decrease risk of overweight and obesity. If fruits and vegetables were able to flourish in convenience stores and farmer’s markets, the desert may begin to support more healthy life!
    1. Dinour, L. M., Bergen, D., & Yeh, M. C. (2007). The food insecurity-obesity paradox: A review of the literature and the role food stamps may play. Journal of the American Dietetic Association, 107(11), 1952-1961.
    2. Buchholz, S. W., Huffman, D., & McKenna, J. C. (2012). Overweight and obese low-income women: Restorative health behaviors under overwhelming conditions. Health Care for Women International, 33(2), 182-197.

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