Week 3 critical discussion

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An apple a day?

F or millions of Americans—especially people living in low-income communities of color— finding a fresh apple is not so easy. Full-service grocery stores, farmers’ markets, and other vendors that sell fresh fruits, vegetables, and other healthy foods cannot be found in their neighborhoods. What can be found, often in great abundance, are convenience stores and fast food restaurants that mainly sell cheap, high-fat, high-sugar, processed foods and offer few healthy options.  

Without access to healthy foods, a nutritious diet and good health are out of reach. And without grocery stores and other fresh food retailers, communities are missing the commercial hubs that make neighborhoods livable, and help local economies thrive.

For decades, community activists have organized around the lack of access to healthy foods as an economic, health, and social justice issue. As concerns grow over healthcare and the country’s worsening obesity epidemic, “food deserts” — areas where there is little or no access to healthy and affordable food—have catapulted to the forefront of public policy discussions. Policymakers at the local, state, and national level have begun recognizing the role that access to healthy food plays in promoting healthy local economies, healthy neighborhoods, and healthy people.

This report, a summary of our current knowledge about food deserts and their impacts on communities, provides evidence to inform this policymaking.

To assess the current evidence base in this dynamic and fast-growing field of research, we compiled the most comprehensive bibliography to date of studies examining food access and its implications conducted in the United States over

the past 20 years. This bibliography incorporates a total of 132 studies: Sixty-one published in peer- reviewed journals and primarily conducted by university-based researchers and 71 conducted by practitioners or policy researchers, sometimes in collaboration with academic researchers, and self-published (also known as “grey literature”). The studies include three nationwide analyses of food store availability and neighborhood, city, county, regional, statewide, and multistate analyses covering 22 states across the country.

Findings

1. Accessing healthy food is a challenge for many Americans—particularly those living in low-income neighborhoods, communities of color, and rural areas. In hundreds of neighborhoods across the country, nutritious, affordable, and high quality food is largely missing. Studies that measure food store availability and availability of healthy foods in nearby stores find major disparities in food access by race and income and for low-density, rural areas.

• Lack of supermarkets. A 2009 study by the U.S. Department of Agriculture found that 23.5 million people lack access to a supermarket within a mile of their home. A recent multistate study found that low- income census tracts had half as many supermarkets as wealthy tracts. Another multistate study found that eight percent of African Americans live in a tract with a supermarket, compared to 31 percent of whites. And a nationwide analysis found there are 418 rural “food desert” counties where all residents live more than 10 miles from a supermarket or supercenter— this is 20 percent of rural counties.

Executive Summary

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• Lack of healthy, high quality foods in nearby food stores. In Detroit and New Haven, produce quality is lower in low-income communities of color compared to more affluent or racially mixed neighborhoods. In Albany, New York, 80 percent of nonwhite residents cannot find low-fat milk or high-fiber bread in their neighborhoods. And in Baltimore, 46 percent of lower-income neighborhoods have limited access to healthy food (based on a healthy food availability survey) compared to 13 percent of higher-income neighborhoods.

• Predominance of convenience/corner/ liquor stores. Nationally, low-income zip codes have 30 percent more convenience stores, which tend to lack healthy items, than middle-income zip codes.

• Lack of transportation access to stores. Residents in many urban areas (including Seattle, Central and South Los Angeles, and East Austin, Texas) have few transportation options to reach supermarkets. Inadequate transportation can be a major challenge for rural residents, given the long distances to stores. In Mississippi—which has the highest obesity rate of any state—over 70 percent of food stamp eligible households travel more than 30 miles to reach a supermarket.

2. Better access corresponds with healthier eating. Studies find that residents with greater access to supermarkets or a greater abundance of healthy foods in neighborhood food stores consume more fresh produce and other healthful items.

• For every additional supermarket in a census tract, produce consumption increases 32 percent for African Americans and 11 percent for whites, according to a multistate study.

• A survey of produce availability in New Orleans’ small neighborhood stores found that for each additional meter of shelf space devoted to fresh vegetables, residents eat an additional 0.35 servings per day.

• In rural Mississippi, adults living in “food desert” counties lacking large supermarkets are 23 percent less likely to consume the recommended fruits and vegetables than those in counties that have supermarkets, controlling for age, sex, race, and education.

3. Access to healthy food is associated with lower risk for obesity and other diet-related chronic diseases. Researchers find that residents who live near supermarkets or in areas where food markets selling fresh produce (supermarkets, grocery stores, farmers’ markets, etc.) outnumber food stores that generally do not (such as corner stores) have lower rates of diet-related diseases than their counterparts in neighborhoods lacking food access.

• A multistate study found that people with access to only supermarkets or to supermarkets and grocery stores have the lowest rates of obesity and overweight and those without access to supermarkets have the highest rates.

• In California and New York City, residents living in areas with higher densities of fresh food markets, compared to convenience stores and fast food restaurants, have lower rates of obesity. 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.

• Using statistical modeling techniques that control for a variety of factors, researchers estimate that adding a new grocery store to a high poverty neighborhood in Indianapolis would lead to a three pound weight decrease among residents, while eliminating a fast food restaurant in a neighborhood with a high density of fast food would lead to a one pound weight decrease.

• In Chicago and Detroit, residents who live farther from grocery stores than from convenience stores and fast food

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restaurants have significantly higher rates of premature death from diabetes.

4. New and improved healthy food retail in underserved communities creates jobs and helps to revitalize low-income neighborhoods. Though the economic impacts of food retailers are understudied, we know that grocery stores contribute to community economic development. Analysis of a successful statewide public-private initiative to bring new or revitalized grocery stores to underserved neighborhoods in Pennsylvania provides positive evidence that fresh food markets can create jobs, bolster local economies, and revitalize neighborhoods. The effort has created or retained 4,860 jobs in 78 underserved urban and rural communities throughout the state. Analyses of stores supported by the effort find they lead to increased economic activity in surrounding communities.

Implications for Policy

The evidence is clear that many communities— predominantly low-income, urban communities of color and rural areas—lack adequate access to healthy food, and the evidence also suggests that the lack of access negatively impacts the health of residents and neighborhoods. These findings indicate that policy interventions to increase access to healthy food in “food deserts” will help people eat a healthy diet, while contributing to community economic development.

For many years, impacted communities and their advocates have been implementing a variety of strategies to increase access to fresh, wholesome foods, including:

• Attracting or developing grocery stores and supermarkets;

• Developing other retail outlets such as farmers’ markets, public markets, cooperatives, farmstands, community-

supported agriculture programs, and mobile vendors (and ensuring public benefits can be used at these venues);

• Increasing the stock of fruits, vegetables, and other healthy foods at neighborhood corner stores or small groceries;

• Growing food locally through backyard and community gardens and larger- scale urban agriculture; and

• Improving transportation to grocery stores and farmers’ markets.

Improving access to healthy food is a critical component of an agenda to build an equitable and sustainable food system. It is time for a nationwide focus to ensure that healthy food choices are available to all, building on these local efforts and innovations.

Smart public policies and programs should support communities in their efforts to develop, implement, and test strategies that increase healthy food access. Government agencies at the local, state, and federal level should prioritize the issue of inequitable food access in low-income, underserved areas. Programs and policies that are working should be expanded and new programs should be developed to bring more grocery stores and other fresh food retail outlets to neighborhoods without access to healthy foods. Transportation barriers to fresh food outlets should be addressed. Whenever possible, policies to address food deserts should link with comprehensive efforts to build strong regional food and farm systems.

Residents of low-income communities and communities of color in urban and rural areas have suffered for too long from a lack of access to healthy food. With local and state programs showing enormous promise, now is the time for policymakers to enact policies that will catalyze the replication of local and state innovations and bring them to a national scale.

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The presence of stores selling healthy, affordable food makes it possible to eat “five a day” and consume a healthful diet.