Food Desert
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Food Desert
A corner shop
A typical urban corner shop. All the food visible is relatively imperishable: dried, processed and tinned products, which may have a low vitamin and nutritional content compared to fresher produce. Shown below is a vegetable counter of a larger supermarket.
Vegetables at a supermarket

A food desert is an area, especially one with low-income and minority residents, that has limited access to affordable and nutritious food. [1][2][3] In contrast, an area with supermarkets is termed a food oasis. The term food desert considers the type and quality of food available to the population, in addition to the number, type, and size of food stores that are accessible.[4] Food deserts are characterized by a lack of supermarkets which decreases residents' access to fruits, vegetables and other whole foods.[5] In 2010, the United States Department of Agriculture (USDA) reported that 18 million Americans live in a food desert, meaning that they live more than one mile from a supermarket in urban or suburban areas, and more than 10 miles from a supermarket in rural areas.[5] Food deserts lack whole food providers who supply fruits and vegetables, and instead provide processed, sugar, and fat laden foods in convenience stores. Processed, sugar, and fat laden foods are known contributors to the United States' obesity epidemic.[6] With limited access to food retailers or supermarkets that stock fresh and healthy foods, populations living in food deserts may experience high rates of diabetes, cardiovascular disease and obesity.[6]

History

By 1973, "desert" was ascribed to suburban areas lacking amenities important for community development.[7] Cummins and Macintyre report that a resident of public housing in western Scotland supposedly invented the more specific term "food desert" in the early 1990s.[8] The phrase was officially used for the first time in a 1995 document from a policy working group of the Low Income Project Team of the UK's Nutrition Task Force.[8]

Initial research was narrowed to the impact of retail migration from the urban center.[9] More recent studies explored the impact of food deserts in other geographic areas (e.g., rural and frontier) and among specific populations, like minorities and the elderly. They address the relationship between the quality (access and availability) of retail food environments, pricing and obesity. The findings support that environmental factors contribute to people's eating behaviors. Research conducted with variations in methods draws a more complete perspective of "multilevel influences of the retail food environment on eating behaviors (and risk of obesity)."[9]

Definitions

Researchers employ a variety of methods to assess food deserts including: directories and census data, focus groups, food store assessments, food use inventories, geographic information system (GIS) technology, interviews, questionnaires and surveys measuring consumers' food access perceptions.[10] Differences in the definition of a food desert vary according to the:

  • type of area, urban or rural[11]
  • economic barriers and affordability of accessing nutritious foods, including the cost of transportation, price of foods, and incomes of those in the area[10][12][8]
  • distance to the nearest supermarket or grocery store[13]
  • amount of supermarkets in the given area[13]
  • type of foods offered, whether it be fresh or prepared[10][8]
  • nutritional values of the foods offered[14]

The multitude of definitions which vary by country have fueled controversy over the existence of food deserts.[10]


2016 USDA map. According to the Medley Food Desert Project[], nearly 24 million Americans live in food deserts. Food deserts are heavily concentrated in southern states, which correlates with concentration of poverty. The map presents percentages of people without cars living in areas with no supermarket within a mile.

Distance

Distance-based measurements are used to measure food accessibility and identify food deserts.

The United States Department of Agriculture (USDA) Economic Research Service measures distance by dividing the country into multiple 0.5 km square grids. The distance from the geographic center of each grid to the nearest grocery store gauges food accessibility for the people living in that grid.[15][16]Health Canada divides areas into buffer zones with people's homes, schools or workplaces as the center. The Euclidean distance, the shortest route distance between the two points of interest, is then measured for gaining food access data.[17]

Different factors are excluded or included that affect the scale of distance. The USDA maintains an online interactive mapping tool for the U.S., the "Food Access Research Atlas," which applies four different measurement standards to identify areas of low food access based on distance from the nearest supermarket.[18]

The first standard uses the original USDA food desert mapping tool "Food Desert Locator" and defines food deserts as having at least 33% or 500 people of a census tract's population in an urban area living 1 mile (10 miles for rural area) from a large grocery store or supermarket.[15][19]

The second and third standards adjust the scale of distance and consider income to define a food desert. In the U.S., a food desert consists of a low income census tract residing at least 0.5 miles in urban areas (10 miles in rural areas) or 1 mile away in urban areas (20 miles in rural areas) from the large grocery store.[18] The availability of other fresh food sources like community gardens and food banks are not included in mapping and can change the number of communities that should be classified as food deserts.[20] A 2014 geographical survey found that the average distance from a grocery store was 1.76 kilometers (1.09 miles) in Edmonton, but only 1.44 kilometers (0.89 miles) when farmers' markets and community gardens were included, 0.11 miles under the latter definition for an urban food desert.[21]

The fourth standard takes vehicular mobility into account. In the U.S., a food desert exists if 100 households or more with no vehicle access live at least 0.5 miles from the nearest large grocery store; for populations with vehicle access, 500 households or more living at least 20 miles away.[18][22] Travel duration and mode may be other important factors.[23] As of 2011, public transport is not included in mapping tools.[20]

Fresh food availability

A food retailer is typically considered to be a healthy food provider if it sells a variety of fresh food, including fruits and vegetables. Types of fresh food retailers include:

Food retailers like fast food restaurants and convenience stores are not typically in this category as they usually offer a limited variety of foods that make up a healthy diet.[15] Frequently too, the produce sold at convenience stores is poor quality.[24] A "healthy" bodega as defined by the New York City Department of Health and Mental Hygiene stocks seven or more varieties of fresh fruits and vegetables and low-fat milk.[25]

Different countries have different dietary models and views on nutrition. These distinct national nutrition guides add to the controversy surrounding the definition of food deserts. Since a food desert is defined as an area with limited access to nutritious foods, a universal identification of them cannot be created without a global consensus on nutrition.

Income and food prices

Other criteria include affordability and income level. According to USDA, researchers should "consider... [the] prices of foods faced by individuals and areas" and how "prices affect the shopping and consumption behaviors of consumers."[26] One study maintains that estimates of how many people live in food deserts must include the cost of food in supermarkets that can be reached in relation to their income.[23]

Rural food deserts

The main difference between a rural and an urban food desert is the distance of residents from the nearest supermarket. Twenty percent of rural areas in the U.S. are classified as food deserts.[27] Within these counties, approximately 2.4 million individuals have low access to a large supermarket.[18][28] This difference in distance translates into pronounced economic and transportation differences between the rural and urban areas.[29][30]

A 2009 study of rural food deserts found key differences in overall health, access to food, and social environment of rural residents compared to urban dwellers.[31] Rural residents report overall poorer health and more physical limitations, with 12% rating their health as fair or poor compared to 9% of urban residents.[31] They believed their current health conditions were shaped by their eating behaviors when the future chronic disease risk was affected by the history of dietary intake.[31] Moreover, the 57 recruited rural residents from Minnesota and Iowa in one study perceived that food quality and variety in their area were poor at times.[31] The researchers reached the conclusion that, for a community of people, while food choice which bound by family and household socioeconomic status remained as a personal challenge, social and physical environments played a significant role in stressing and shaping their dietary behaviors.[31]

Beyond physical access

The primary criterion for a food desert is its proximity to a healthy food market. When such a market is in reach for its residents thereby eliminating the food desert, it does not mean that residents now will eat healthy. A longitudinal study of food deserts in JAMA Internal Medicine shows that supermarket availability is generally unrelated to fruit and vegetable recommendations and over diet quality.[] The availability of unhealthy foods at supermarkets may impact this relation. Simply providing healthier food access, according to Janne Boone-Heinonen et al., cannot completely eliminate food deserts, this access must be paired with education.[][32]

Access to food options is not the only barrier to healthier diets and improved health outcomes. Wrigley et al. collected data before and after a food desert intervention to explore factors affecting supermarket choice and perceptions regarding healthy diet in Leeds, United Kingdom. Pre-tests were administered prior to a new store opening and post-tests were delivered 2 years after the new store had opened. The results showed that nearly half of the food desert residents began shopping at the newly built store, however, only modest improvements in diet were recorded.[33][34]

A similar pilot study conducted by Cummins et al. focused on a community funded by the Pennsylvania Fresh Food Financing Initiative. They conducted follow up after a grocery store was built in a food desert to assess the impact. They found that "simply building new food retail stores may not be sufficient to promote behavior change related to diet."[35] Studies like these showed that living close to a store stocked with fruits and vegetables does not make an impact on food choices. [36]

A separate survey also found that supermarket and grocery store availability did not generally correlate with diet quality and fresh food intake.[37] Pearson et al. further confirmed that physical access is not the sole determinant of fruit and vegetable consumption.[38] Impediments common with places that are not food deserts remain.

Work and family

People who have nonstandard work hours that include rotating or evening shifts may have difficulty shopping at stores that close earlier and instead shop at fast food or convenience stores that are generally open later.[20][39] Under welfare-to-work reforms enacted in 1996, a female adult recipient must log 20 hours a week of "work activity" to receive SNAP benefits.[40] If they live in a food desert and have family responsibilities, working as well may limit time to travel to obtain nutritious foods as well as prepare healthful meals and exercise.[40]

Safety and store appearance

Additional factors may include how different stores welcome different groups of people[20] and nearness to liquor stores.[41] Residents in a 2010 Chicago survey complained that in-store issues like poor upkeep and customer service were also impediments.[41] Safety can also be an issue for those in high crime areas, especially if they have to walk carrying food and maybe also with a child or children.[41]

Fast food

A possible factor affecting obesity and other "diet-related diseases" is the proximity of fast food restaurants and convenience stores compared to "full-access" grocery stores.[15] Proximity to fast food restaurants correlates with a higher BMI, while proximity to a grocery store correlates with a lower BMI, according to one study.[15]

A 2011 review used fifteen years of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study to examine the fast-food consumption of more than 5,000 young American adults aged 18-30 years in different geographic environments.[37] Fast food chain, supermarket or grocery store availability was treated as a parameter of fast food consumption, diet quality and participants' preferences to fresh fruits and vegetables. The key results of this longitudinal study include:

  • Fast food consumption was directly related to the proximity of fast food restaurants among low-income participants;
  • For participants with restaurants within 1.00 to 2.99 km of home, approximately 1% increase in fast food supplies was correlated to a 0.13% and 0.34% increase in fast food consumption for the distance within 1 km and 3 km;[37]
  • Fast food access and individual consumption were not essentially related among the female participants of any income level;
  • Men had a higher frequency of fast food consumption than women.

The research team concluded that "alternative policy options such as targeting specific foods or shifting food costs (subsidization or taxation)" may be complementary and necessary to promote healthy eating habits while increasing the access to large food stores in specific regions and limit the availability of fast food restaurants and small food stores.[37] Some cities already restrict the location of fast food and other food retailers that do not provide healthy food.[42]

Fast food restaurants are disproportionately placed in low-income and minority neighborhoods and are often the closest and cheapest food options.[] "People living in the poorest SES areas have 2.5 times the exposure to fast-food restaurants as those living in the wealthiest areas".[43]

Behavior and social and cultural barriers

Other studies have documented a sense of loyalty towards the owners of neighborhood convenience stores as an explanation as to why residents may not change their shopping behaviors.[10]

Steven Cummins also proposed that food availability is not the problem: it is eating habits.[44] Pearson et al. urge food policy to focus on the social and cultural barriers to healthy eating.[38] For instance, New York City's public-private Healthy Bodegas Initiative has aimed to encourage bodegas to carry milk and fresh produce and local residents to purchase and consume them.[45]

Implications for Self Care

Self care is an essential component in management of chronic conditions and for those who are healthy. Self care is greatly influenced by food choices and dietary intake.[46] Limited access to nutritious foods in food deserts can greatly impact one's ability to engage in self care. Access, affordability, and health literacy are all social determinants of health, which are accentuated by living in a food desert.[47] There are two main health implications for those living in food deserts: overnutrition or undernutrition.[48] The community may be undernourished, due to inability to access food stores. The community may be overnourished due to a lack of affordable supermarkets with whole foods and a higher concentration of convenience stores and fast-food restaurants that offer pre-packaged foods often high in sugar, fat, and salt.[48]Food-insecurity remains a problem for many low-income families, but the greatest challenge to living in a food desert is poor diet quality. Living in a food desert contributes to a higher prevalence of chronic diseases associated with being overweight.[49] Persons living in a food desert often face barriers to self-care, particularly in accessing resources needed to change their dietary habits.

Transportation and Geography

People tend to make food choices based on what is available in their neighborhood. In food deserts there is often a high density of fast-food restaurants and corner stores that offer prepared foods.[50]

In rural areas food security is a major issue. Food security can imply either a complete lack of food, which contributes to undernourishment, or a lack of nutritious food, which contributes to over-nourishment.[51]

According to the United States Department of Agriculture (USDA)[52], community food security "concerns the underlying social, economic, and institutional factors within a community that affect the quantity and quality of available food and its affordability or price relative to the sufficiency of financial resources available to acquire it.[53] Rural areas tend have higher food insecurity than urban areas. This insecurity occurs because food choices in rural areas are often restricted because transportation is needed to access a major supermarket or a food supply that offers a wide, healthy variety versus smaller convenience stores that do not offer as much produce.[54]

It is critical to look at car ownership in relation to the distance and number of stores in the area. Distance from shops influences the quality of food eaten.[55]A car or public transportation is often needed to access a grocery store. When neither a car or nor public transportation is available, diets are rarely healthy. This is because fast food and convenience stores are easier to access and do not cost much money or time. Further, those who walk to food shops typically have poorer diets, which has been attributed to having to carry shopping bags home.[56]

Adherence

Long-term adherence to a healthy, balanced diet is essential to promote the well-being of individuals and society. Many approaches to helping people eat a healthy, balanced diet are ineffective because of "adherence problems" with behavior changes.[57]There is no universal definition of dietary adherence, but we know that dietary adherence is influenced by habits that develop over a lifetime.[58]

It is especially difficult to "adhere" to a prescribed diet and lifestyle (ex. low salt diet, low fat diet, low carbohydrate diet, low sugar diet) when living in a food desert without enough access to items needed. When high sugar, high fat, and high salt items are the only foods available to people living in a food desert, dietary adherence requires (a) shift in lifestyle/ eating habits and (b) access to fresh, healthy, affordable foods.[59]

Decision Making

Decision-making is an important component of self-care that is affected by food deserts. People employ both rational and naturalistic decision-making processes on a routine basis. Naturalistic decisions occur in situations where time is limited, stakes are high, needed information is missing, the situation is ambiguous and the decision-maker is uncertain. Rational decisions are more likely when people have time to weigh options and consider the consequences.[60]

The way individuals living in a food desert make decisions about healthy eating is influenced by a variety of factors. Communities with higher than state average poverty statistics often report low access to affordable food, thus limiting their ability to maintain a healthy diet.[61] For these families living in poverty, many people work multiple jobs with rotating or evening shifts that make it difficult to find time to shop for food.[62][5] Time constraints affect decision-making and people often choose to go to a closer convenience store rather than travel farther for fresh food.[63] Families in urban food deserts may lack access to a car, which adds to the time needed to shop for groceries.[6] Additionally, convenience stores and corner stores are typically open later hours than a traditional grocery store, making them more accessible.[64]

Another factor that impacts those living in a food desert is safety. High rates of crime are a barrier for those living in food deserts.[65] If people feel unsafe traveling farther to a grocery store, they are more likely to decide to purchase less healthy options at a closer location. In this way, people prioritize their safety over fresh, healthy foods.[65]

Proximity to fast-food restaurants also influences decisions made when choosing meals. Proximity to fast food restaurants is related to having a higher BMI, while proximity to a grocery store is associated with a lower BMI.[66] One study found that people living in the poorest areas of the country have more than twice the exposure to fast-food restaurants compared to people living in wealthy areas.[67] Another study used 15 years of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study to examine the fast-food consumption of more than 5,000 young American adults aged 18-30 years in different geographic areas of the US.[68] Proximity to fast food or a supermarket/grocery store was used to predict the type of food consumed.[68] In low-income study participants, the type of food consumed was directly related to the proximity of fast food restaurants.[68] These results suggest that low-income persons living in a food desert make decisions to consume fast food based on proximity to fast food restaurants versus distances to a grocery store.[68]

Health Literacy

While access poses a major barrier to the practice of self-care in food deserts, health literacy remains a common barrier to nutritional behavioral choices. Health literacy and food deserts can affect all sectors of the population, but it is known that they both unjustly affect underserved, low-income individuals.[69] Health literacy is the ability to obtain, read, understand, and use health information in order to make appropriate health decisions and follow instructions for treatment.[70] Health literacy affects the ability to perform self-care by influencing decision making and relationships with health care professionals. Additionally, health literacy and self-efficacy can predict the likelihood of reading food labels, which predicts dietary choices.[71] A study of young adults in a metropolitan area found that those with low health literacy used food labels significantly less than a high health literacy group, suggesting that low health literacy may negatively influence dietary quality.[71] Overall, these data suggests that health literacy is a key factor in explaining differences in dietary habits, as healthy eating is associated with higher nutrition literacy skills.[72][73]

When considering health literacy and dietary self-care behavior, a study of persons with heart failure found that those with low health knowledge had poor self-care behaviors.[74] This study reveals how health literacy influences one's ability to manage a  health condition and make healthy choices. Gaining access to fresh and affordable food is essential to improving health and decreasing social disparities in those living in food deserts. Increasing health education and resources to improve health literacy are also vital in order for individuals to engage in healthy behaviors, adhere to dietary recommendations, and practice self-care.  

Initiatives and Resources

Recognition of food deserts as a major public health concern has prompted a number of initiatives to address the lack of resources available for those living in both urban and rural areas. On the larger scale, there have been national public policy initiatives.

Federal and State Policy Initiatives

In 2010, the US Department of Health and Human Services, the US Department of Agriculture, and the US Department of the Treasury announced their partnership in the development of the Healthy Food Financing Initiative (HFFI). With the goal of expanding access to healthy food options in both urban and rural communities across the country, HFFI has helped expand and develop grocery stores, corner stores, and farmers' markets, by providing financial and technical assistance to communities. The creation of these resources provides nutritious food options to those living in food deserts.[75] The HFFI has awarded $195 million to community development organizations in 35 states. Between 2011 and 2015, HFFI created or supported 958 projects aimed at healthy food access.[76] The HFFI has also supported the development of statewide programs across the country, in California, Colorado, Illinois, Louisiana, Michigan, New Jersey, New York, Ohio, and Pennsylvania.[77] In Pennsylvania, the state program called the Fresh Food Financing Initiative (FFFI) provides grants and loans to healthy food retailers to create or renovate markets, including large supermarkets, small stores, and farmers' markets, in low income urban and rural areas across Pennsylvania. Because operating in underserved areas is more financially straining on retailers, the program provides subsidized financing incentives for retailers to open in areas where need is high. The Pennsylvania program's success influenced many other states to launch similar programs.[78]

Farmers' Markets and Community Gardens

Local and community efforts have made strides in combatting lack of access to nutritious food in food deserts. Farmers' markets provide local residents with fresh fruits and vegetables. Usually in a public and central areas of a community, such as a park, farmers' markets are most effective when they are easily accessible. Farmers' markets tend to be more successful in urban than rural areas due to large geographic distances in rural areas that make the markets difficult to access.[79] The expansion of the Supplemental Nutrition Assistance Program (SNAP) to farmers' markets also helps make nutritious foods increasingly affordable. Each year, SNAP program participants spend around $70 billion in benefits; as of 2015, more than $19.4 billion were redeemed at farmers' markets.[80] The Double Up Food Bucks program doubles what every Electronic Benefit Transfer (EBT) dollar spent at a farm stand is worth.[81] This incentivizes locals to shop for fresh over processed foods. Community gardens can play a similar role in food deserts, generating fresh produce by having local residents share in the maintenance of food production.[82] Community gardens also address fresh food scarcity. The nonprofit group DC Urban Greens operates a community garden in Southeast Washington, D.C., an area labeled by the US Department of Agriculture as a food desert. The garden provides fresh produce to those in the city who do not have easily accessible grocery stores nearby. The organization also sets up farmers' markets in the city.[83] In the food desert of North Las Vegas, a neighborhood with one of the highest levels of food insecurity, another community garden is addressing food scarcity.[84]

Meal Delivery, Food Trucks, and Ride Shares

An entrepreneurial solution to food insecurity in food deserts is food trucks. In major urban centers such as Boston, mobile food markets travel to low income areas with fresh produce. The trucks travel to assisted living communities, schools, workplaces, and health centers.[85] The increased availability of online food retailers and delivery services, such as AmazonFresh and FreshDirect, can also help in food deserts by delivering food straight to residences. The ability for elderly people, disabled people, and those who live geographically far from supermarkets to use SNAP benefits online to order groceries is a major resource.[86] For those who lack transportation options, rideshare services such as Uber and Lyft may be vital resources to increase access to nutritious foods in food deserts.[87]

Geisinger Health Services Fresh Food Pharmacy

In central Pennsylvania, an innovative solution to food insecurity for persons with diabetes is the Fresh Food Pharmacy, which considers access to nutritious foods as vital as access to prescription medicine. Free groceries, all compliant with the American Diabetes Association guidelines, are provided to those in this program.[88] This unique program to address food insecurity for those with chronic illnesses is a major resource for promoting self-care in food deserts.

See also

References

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