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Food and health in a failing economy

ASK THIS | February 23, 2009

Judith Bell of the advocacy group PolicyLink lays out the dramatic correlations, in low-income neighborhoods, between the lack of healthy food choices and the onset of obesity and diabetes.

By Judith Bell

Q. As the economy worsens, and the need for food stamps rises, how will food choices – and food options – change for Americans? Will diets become even less healthy as millions of people turn to low-cost, low-nutrition food out of necessity? What will this mean for the nation’s already troubling obesity and diabetes crises?

A. The answer, for better or worse, is found to a great extent in the type of food markets that neighborhoods offer, or don’t offer. In too many neighborhoods, particularly in urban and rural low income communities and communities of color, healthy food choices are few and far between

[Editor's note: This article and the illustrations in it are an example of basic computer-assisted reporting, easily replicable in almost all urban areas. They tell an important story, especially now that the President and Congress have enacted a stimulus package that provides both money and a new spotlight on poverty and health issues.]

Q. To what extent are low-income people, particularly people of color, at a disadvantage in affording and obtaining a healthy diet? How do neighborhood factors impact food choices? How easy is it to purchase healthy foods?  Do all neighborhoods have similar choices? What’s the density of grocery stores in different cities? 

A. In the midst of an epidemic of obesity and diabetes, with escalating numbers of children affected, we need to look beyond the typical platitudes of having better diets. Many low and moderate income neighborhoods, particularly communities of color, lack a grocery store. The city of Detroit lacks a major national chain grocery store. In many low-income neighborhoods, residents must travel far to reach a store with healthy food options. Below are maps of Louisville (and a report from the Community Farm Alliance) showing the density of grocery stores there. The two outlined neighborhoods—West Louisville and East Downtown, both predominantly African American (80%) and poor, have two grocery stores—about two stores for 75,000 residents. The rest of the city has one store for every 6,100 residents. 

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Q.  What are the options in neighborhoods without grocery stores? What kind of food is available in corner stores? What is not? What other options are available? 

A.   The neighborhoods without grocery stores tend to have a high density of corner stores. Healthy choices are not easy in these neighborhoods. Corner stores have few if any fresh fruits and vegetables and an over-abundance of junk food, high in fat and salt. (See the map below showing the density of convenience stores in Louisville.) The  neighborhoods with very few grocery stores, have the greatest number of convenience stores. 

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Q.  How easy is it for residents to reach grocery stores?

A. Ironically, the neighborhoods without easy access to grocery stores are the same neighborhoods that typically have the highest number of residents without easy access to use of a car. Thus, residents are even more likely to need to rely on convenience stores, with their many unhealthy food choices or nearby fast food outlets. See the map, below left, showing the number of residents without access to a car -- 40-70% in West Louisville and East Downtown. And below right, see the many available fast food outlets in these same neighborhoods with the fewest available grocery stores.

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Q.  Is there a connection between the lack of access to healthy foods and obesity and diabetes? 

A. Maps showing lack of access to healthy foods (neighborhoods without grocery stores, or with very few) are very similar to those showing a high incidence of diabetes and obesity. The New York City Department of City Planning and the New York City Department of Health and Mental Hygiene mapped the density of bodegas/corner stores and then mapped obesity and diabetes rates. While bodegas make up about two-thirds of the food stores in East and Central Harlem, they make up only one-third in the Upper East Side, half the proportion. In contrast, 19% of the food stores in the Upper East Side are supermarkets, more than double the 8% of East and Central Harlem. Bodegas in the Upper East Side have a 57% chance of having skim milk, compared to 33% in Central and East Harlem bodegas, and a 20% chance of having leafy green vegetables, as opposed to a 2% chance in Central Harlem and 4% chance in East Harlem. Neighborhoods without access to healthy foods are the same ones that show high incidence of diabetes and obesity.  (See slides below.)

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Q.  But is the lack of access to healthy foods tied to obesity and diabetes?  Do neighborhood factors really matter? 

A. My group, PolicyLink, along with UCLA and the California Center for Public Health Advocacy, explored this question for California communities. We looked at the prevalence of convenience stores and fast food outlets compared to the number of grocery stores and produce vendors and found that low-income neighborhoods have worse food environments. Obesity and diabetes prevalence is highest in such areas. These findings suggest that improving the retail food environment could be a promising strategy for decreasing the prevalence of obesity and diabetes in California. (Click here for our report.)

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