Food insecurity and the lack of access to affordable, nutritious food are significant public health concerns, particularly impacting lower socioeconomic status (SES) individuals and racial and ethnic minority groups. These disparities lead to poor dietary quality and an increased risk of diet-related diseases, including cardiovascular disease, diabetes, and certain types of cancer.
In the United States, approximately 13.5 million people face limited access to supermarkets or large grocery stores, resulting in poor access to fresh and healthy foods. Despite growing research, significant gaps remain in our understanding of the pathways linking food insecurity and neighborhood food environments to racial/ethnic and socioeconomic health disparities, as well as the most effective intervention strategies.
To address these issues, the National Institutes of Health (NIH), in collaboration with the Centers for Disease Control and Prevention (CDC) and the United States Department of Agriculture (USDA), convened a virtual workshop in September 2021 titled “Food Insecurity, Neighborhood Food Environment, and Nutrition Health Disparities: State of the Science.” This article reports on the workshop proceedings and highlights critical discussions, gaps, and opportunities for future research on food insecurity, neighborhood food environments, and health disparities.
Understanding Food Deserts
Some neighborhoods in the United States, particularly those in low-income areas, have been dubbed “food deserts” because residents do not live near supermarkets or other food retailers that carry affordable and nutritious food. A lack of healthy options could lead to poor diets and to diet-related conditions such as obesity or diabetes.
Defining what lack of access to affordable and nutritious food means and estimating how many people are affected by living in food deserts is not straightforward. A number of different measures are possible.
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Perhaps the best measure of whether someone who lives far from a grocery store faces obstacles to accessing affordable and nutritious food is whether or not he or she has a car. Access to a car allows people to leave the food desert and shop at supermarkets and large grocery stores outside of their neighborhoods. But not everyone has regular access to a car.
Some neighborhoods lacking supermarkets may be served by smaller grocery or convenience stores which may offer some healthy foods, but often at higher prices than supermarkets. Higher prices at these food retailers compound the problem of limited access to healthy foods.
A food-desert neighborhood may lack a supermarket or large grocery store because of the costs food retailers face when building and/or operating a store in those locations.
Food deserts are likened to physical desert regions because the search for and acquisition of nutritious foods is not easily accomplished in either environment. Indeed, food deserts often are not readily traversed, particularly by people without cars who rely on public transportation. Furthermore, if nutritious foods are available, they often are unaffordable.
Despite the uncertainties concerning the origins of food deserts, research has suggested that economic factors, such as supply and demand, as well as urban planning, which serves to connect consumers to food retailers and transportation services, are at play.
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The study of food deserts has drawn attention to disparities in food availability, diet, and health that are associated with income level, ethnicity, and local food environment. In some states, wealthy neighborhoods were found to have more supermarkets than poor neighborhoods, and the same was true for predominantly white versus predominantly black neighborhoods.
One local nonprofit is fighting back with a 44-foot-long refrigerated trailer. Called The Mobile Grocer, this mini supermarket-on-wheels travels to different neighborhood food deserts.
The USDA also measures household vehicle access, a key factor that can overcome access barriers for people living far from grocery stores.
Our country’s system has generally resulted in low-income communities having a higher concentration of small corner stores, convenience markets and fast food vendors, with fewer healthy food options.
Healthy food costs more. When researchers from Brown University and Harvard University studied diet patterns and costs, they found that the healthiest diets - meals rich in vegetables, fruits, fish and nuts - were, on average, $1.50 more expensive per day than diets rich in processed foods, meats and refined grains.
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Federal, state and local policy solutions are needed to address inadequate and inequitable access to high-quality food.
Food deserts exist right here in the US, and there are likely some in the state where you live.
The USDA defines two primary variations:
- Low-income urban neighborhoods where most people live at least a mile from the nearest source of fresh foods (such as a grocery store).
- Low-income rural regions where most people live at least ten miles from the nearest source of fresh foods.
What Are Food Deserts, And How Do They Affect Health? - The Health Brief
Two related terms, food swamps and food insecurity, also factor into this discussion.
Food Swamp: A food swamp refers to an urban area where fresh food options may be present, but they are greatly outnumbered by over-processed food sources such as fast food and corner stores. Someone who lives in a food swamp may have plenty of food access but struggle with nutrition.
Food Insecurity: Food insecurity occurs when people don’t have enough access to food, whether fresh or processed.
The USDA breaks this into two categories as well:
- Low food security (formerly called food insecurity without hunger) occurs when someone gets enough food to eat, but their food is low quality, has little variety, or is undesirable.
- Very low food security (formerly food insecurity with hunger) describes those with disrupted eating patterns or not enough food to eat.
It’s important to note that food insecurity can exist within food deserts, but it can also happen in areas with plenty of fresh food available.
One significant problem with food deserts is that people may not recognize them. The people who live there may appear to be well-fed. Much like in food swamps, they may have plenty of access to convenience foods.
There are several reasons that food deserts occur. These include:
- Lack of transportation - A neighborhood where most people have a car or other motor vehicle can be quite a bit further from a grocery store and still have access to it than a neighborhood where most people have no vehicle.
- Low-Income Communities - As noted above, food deserts exclusively exist in low-income neighborhoods.
- Racial and ethnic disparities - A paper published in BMC Nutrition states that “minority populations across the nation need to drive a significantly greater (p < 0.05) amount of time to reach” healthy foods than white populations.
- Urbanization and land-use policies - In highly urbanized areas with densely populated neighborhoods, space comes at a premium. Since most grocery stores take up a lot of space, it’s often too expensive for them to purchase or lease space in urban areas.
Food deserts lead to many problems for the local population.
Understanding Food Insecurity
According to the USDA, food security (“access by all people at all times to enough food for an active, healthy life”) is one of the several conditions necessary for a population to be healthy and well nourished. In contrast, food insecurity “means that households were, at times, unable to acquire adequate food for one or more household members because they had insufficient money and other resources for food”.
Food insecurity is a significant public health concern in the United States, affecting 10.2% (13.5 million) of all households in 2021. Rates of food insecurity were higher than the national average for households with children (12.5%), households with children headed by a single female (24.3%) or a single male (16.2%), households with incomes <185% of the poverty threshold (26.5%), and households headed by Black (19.8%) and Hispanic (16.2%) individuals.
Although initial reports predicted a significant increase in food insecurity after the start of the COVID-19 pandemic in March 2020, overall rates of food insecurity remained unchanged from 2019 to 2021. However, food insecurity rates for those most at risk, including Black and Hispanic households, increased.
Although food security primarily centers on the access to adequate quantities of food, given the linkages between food insecurity and diet-related disease, the concept of nutrition security emerged to better include considerations of dietary quality and nutritional adequacy. Specifically, as indicated by USDA, nutrition security is defined by the USDA as “all Americans [having] consistent and equitable access to healthy, safe, affordable foods essential to optimal health and well-being”.
Consistent evidence indicates that individuals and households that are socially vulnerable, specifically those experiencing poverty, material hardship, unemployment, and racial discrimination, are at greater risk of food insecurity.
Although workshop speakers acknowledged the important role of individual and household drivers, a key theme was the importance of moving beyond the individual- and household-level factors to include understanding multilevel determinants such as neighborhood conditions and city/state, national, and federal policies.
Multiple pathways (e.g., psychological, behavioral, and immune) link food insecurity and health outcomes, including obesity and cardiometabolic diseases. Food insecurity is also associated with immune activation and inflammation, with poor diet quality impacting the composition and response of the microbiome, which impairs immune functioning, all contributing to worse cardiometabolic health.
Consequences of Food Deserts and Food Insecurity
Food insecurity and the lack of access to affordable, nutritious food are associated with poor dietary quality and an increased risk of diet-related diseases, including cardiovascular disease, diabetes, and certain types of cancer.
Easy access to less healthy, energy-dense foods, particularly if they are convenient and cheap, may swamp out healthier choices. Some recent studies have found an association between the proximity of small stores or fast food restaurants and body mass index.
Food deserts make it difficult for residents to access healthy foods and proper nutrition. They often lead to health problems such as obesity, diabetes, heart disease, and vitamin deficiencies.
Food deserts promote malnutrition and first-world health problems such as obesity and heart disease. These health outcomes are often debilitating and pass down from generation to generation, spreading throughout the entire community and causing significant public health challenges, often leading to death.
When residents have limited access to fresh foods, they are more likely to consume over-processed junk foods, which leads to obesity.
Those who live in food deserts don’t have the same access to fresh, healthy foods, which can lead to serious and potentially deadly health concerns.
Addressing the Issue: Solutions and Interventions
So the question becomes, how to solve food deserts and provide equal access to fresh foods to all people, regardless of their socioeconomic status? Fortunately, several solutions are at work to help fix this problem, though we still have a long way to go toward solving food insecurity and access problems.
The NIH workshop also explored the current evidence on clinical, policy, and community-based interventions and implementation approaches to address food insecurity and promote health equity. Administered by the USDA Food and Nutrition Service, the 16 federal nutrition assistance programs, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), SNAP, and the National School Lunch Program (NSLP) and the School Breakfast Program, provide the most robust response for preventing and alleviating the burden of food insecurity in the United States.
Over the last decade, innovative interventions to alleviate the nutritional consequences of food insecurity at the local, state, and national levels have emerged across multiple settings (e.g., health care, community-based organizations, and government). Some examples of interventions include nutrition incentive programs to increase healthy food purchases, produce prescriptions, medically tailored meals, grocery, food packages, and grocery delivery services, screen and referral programs, on-site pantries, and creating stronger linkages between health care, food assistance programs, and the charitable food system.
One of the largest national nutrition investments is the Gus Schumacher Nutrition Incentive Program (GusNIP), a USDA-funded program with the goal to support health and reduce food insecurity by promoting the purchase and consumption of fruits and vegetables among low-income consumers. In 2019-2020, USDA NIFA funded 52 GusNIP projects with awards covering all 4 United States regions.
In the healthcare setting, focusing on chronic diseases such as cardiometabolic disease and cancer, 1 presentation shared preliminary results from a randomized controlled trial examining the impact of 3 different interventions on food insecurity and treatment outcomes in patients with cancer.
Some public policy interventions to increase access to affordable and nutritious food simultaneously promote healthier choices among residents and a better supply of those choices. For example, New York City has implemented the Healthy Bodegas and Health Bucks programs to address disparities in access to some specific healthy foods.
Policies to encourage the supply of affordable and nutritious food in underserved areas, such as zoning modifications and grants or loans for new store development, will not affect residents’ health if they do not change their food-purchasing behavior or do not have the time or knowledge to prepare healthier foods.
The Healthy Bodega Initiative recruits bodegas or small corner stores in nutritionally vulnerable areas to increase their offerings of low-fat milk, fruit, and vegetables. The Health Bucks program, which began in 2005, offers $2 coupons to people in vulnerable areas for the purchase of fresh fruit and vegetables at participating farmers’ markets, generating business for farmers and reducing food access barriers for residents.
Here are some ways to solve food deserts:
- Tax incentives offered for grocery stores built within low-income, low-access areas help bring food solutions into the communities that need them most.
- Increased funding for public transit allows residents to more easily access food options that are not within walking distance.
- Government-sponsored gardens and urban farming initiatives bring food production into low-income communities where nutrition is often lacking.
The private sector is also working toward a food desert solution.
- Mobile grocery stores and food trucks bring natural foods to those who need them most.
- Community-supported agriculture programs provide both fresh foods and often nutritional education to the local community.
- Vertical farming and hydroponic technology offer a way to grow fresh vegetables at scale in an urban setting, offering these communities available hydroponic produce grown in their own neighborhoods.
Food deserts in St. Louis, Missouri. Source: USDA Economic Research Service.
Jim Wilson, who operates the certified naturally grown farm, Atlanta has seen growth in the city’s access to fresh food. “In my mind, that little lady that walks up here pushing her basket that needs food for her and her grandchildren - those are the people that I really want to have an impact on,” he says. “Food is the tool. Community organizing is what we really do,” Wilson says.
