Food deserts are a complex public health issue that has garnered a wealth of exposure due to Michelle Obama’s obesity initiative. Although a number of solutions have been offered to combat food deserts, most of them have considerable drawbacks.
Like with many public health issues, community-based approaches have been proposed to make a dent in food deserts. Community gardens and fresh markets have been the most salient of these suggestions. However, for urban areas in the North, harsh winters are hardly conducive to growing fresh produce locally. Hence, these would merely serve as seasonal solutions for urban areas like Chicago, IL, New York, NY and Camden, NJ, which are some of the nation’s largest food deserts.
Some believe eradicating food deserts is as simple as adding more supermarkets in low-income areas. It makes sense, right? People don’t live near a supermarket with fresh, affordable food, so you build supermarkets closer to their home, and the problem goes away.
This comes with a couple of caveats, however.
One, quite obviously, is cost. Supermarkets are expensive to build and maintain, so adding supermarkets in every food desert in the country is hardly realistic.
Another issue is the growing uncertainty of the role that supermarkets play in obesity.
“The more we learn about food access, the more we question whether obesity is caused by food access alone,” said Dr. Bradley Appelhans, an assistant professor of preventive medicine at Chicago’s Rush University Medical Center.
A 2012 study led by Victoria Shier of RAND Corporation found no evidence to support the belief that improved access to large supermarkets results in lower youth BMI or that greater exposure to fast food restaurants, convenience stores and small food stores increases BMI.
Some have even labeled these low-income areas as “food swamps” rather than food deserts. Low-income areas are often engulfed in junk food marketing that overshadows healthier options. Hence the term “food swamps”. Thus, even if there are healthier options available, that’s not a guarantee that people will purchase healthier food. Anyone that has set foot in a supermarket understands the determination it takes to ignore the barrage of fatty and sugary foods that tend to decorate the endcaps of aisles in supermarkets.
A report by the USDA in 2009 showed that proximity to fast-food restaurants slightly increased BMI, conflicting with the results of Shier’s study. However, different studies define food deserts and relevant populations differently, so differences in methodology can yield two completely different results. Regardless, the link between food access and obesity needs to be examined in greater depth before any large-scale construction could occur.
To qualify as a food desert, the area has to fail to satisfy one of three conditions: fresh food must be physically accessible; fresh food must be affordable; or the relevant population must have the nutritional knowledge and mental attitude to make healthy choices.
Physical access and financial access are often the most talked about when it comes to food deserts, because they can be quantified. Of all households in the United States, 2.3 million live more than a mile from a supermarket and do not have access to a vehicle, according to a USDA report in 2009.
What that statistic doesn’t show is people’s knowledge of healthy eating habits or their mindset towards eating healthy.
So what other options are there to combat food deserts?
Education is always an important strategy. Greater nutritional knowledge has shown to lead to greater intakes of fruit and vegetables, according to a 2004 study led by Dr. Nadine Sahyoun at the University of Maryland.
Although education would help attack the issue of knowledge, it still doesn’t address the question of physical proximity.
Perhaps the most novel approach to emerge is the use of online grocery stores. The Baltimore public health department undertook this approach with the implementation of an online grocery service known as Baltimarket.
The Baltimore public health department partnered with a local supermarket, and residents of the city can place an order online and have their groceries delivered from the supermarket. Rather than making a time-consuming trip to the supermarket or going to a convenience store with fewer healthy options, residents can have their groceries delivered. The main issue with this program, however, is that groceries are delivered to a local library rather than directly to the customer’s home.
Dr. Bradley Appelhans, an assistant professor at Rush University, carried out a study of the practicality of implementing an online grocery service in the city of Chicago, and found partial support for the idea.
Chicago ranks as one of the nation’s largest food deserts with nearly 600,000 Chicagoans residing in a food desert. In a typical African-American neighborhood in Chicago, the nearest grocery store is roughly twice as distant as the nearest fast food restaurant, according to a report by the Mari Gallagher Research & Consulting Group.
Appelhans used an existing online grocery service known as Peapod for his study. He described it as more of a “boutique” service than one catering to vulnerable populations. This is evidenced by the fact that Peapod doesn’t accept SNAP, formerly known as the Food Stamp program, and the area used for the study was the only area of Chicago that was both a food desert and a Peapod delivery zone.
Research participants were given an $80 voucher to purchase groceries online. Afterwards, they took surveys to assess whether an online grocery service is actually feasible.
Through this study, Appelhans discovered two things. For one, people buy a mix of healthy and unhealthy food.
Food and vegetables represented a large proportion of participants’ expenditures while candy and sweets represented a small proportion of expenditures. However, many participants also purchased caloric beverages. Appelhans notes that online grocery service efforts would need to be paired with programs aimed at reducing the consumption of caloric beverages.
Secondly, a well-implemented online grocery service would have competitive prices, deliver groceries within one day, accept food assistance (i.e., SNAP) and be accessible through the home.
Perhaps the largest benefit of this approach would be its cost-effectiveness. It wouldn’t require large-scale construction of “brick and mortar” stores, but could use infrastructure already in place. The ideal online grocery service would resemble Baltimarket in that it would be a partnership of public health departments and local supermarkets. However, unlike Baltimarket it would offer home delivery.
In the study, deliveries generally came within one to two days at the soonest, according to Appelhans. Hence, delivery times would need to be fast and consistent for this strategy to actually work.
On the surface, home internet access would appear to be an issue. One would infer that people in low-income areas that don’t have access to a car are probably less likely to have access to home internet. However, actions taken by Chicago’s mayor Rahm Emanuel and President Obama show signs of a narrowing digital divide.
In 2011, Emanuel announced the launch of Comcast’s “internet essentials”, a partnership between the city of Chicago and Comcast aimed at offering broadband internet at a reduced rate for low-income families. The program helped nearly 7,000 Chicago families gain internet access by the end of the first year, according to Comcast.
In his 2011 State of the Union address, President Obama called for a National Wireless Initiative to make high-speed wireless internet available to at least 98 percent of Americans.
Appelhan’s study found that a significant proportion of the sample (74 percent) had home internet access. In fact, a higher percentage of research participants had home internet access than had a car.
The study is not without its limitations, however. For one, the study only looked at a small segment of the city of Chicago rather than the whole compendium of food deserts across the nation. Furthermore, it only looked at the sample for one grocery shopping experience rather than across a period of weeks or months.
Ultimately, more studies are necessary to determine if this is a strategy that could applied across the nation. Despite the limitations of the study, Appelhans remains hopeful.
“This could potentially be a really valuable strategy to address the problem of food deserts” said Appelhans.
RAND Corporation - “Is There a Robust Relationship Between Neighbourhood Food Environment and Childhood Obesity in the USA?”
Nadine Sahyoun - “Evaluation of nutrition education interventions for older adults: a proposed framework.”
Mari Gallagher Research & Consulting Group - “Examining the Impact of Food Deserts on Public Health in Chicago”
President Obama - 2011 State of the Union Address
Image: by author.