If You Build It, Will They Come? The Relationship Between Healthy Food Access and Consumption.

, food systems & health analyst | February 4, 2015, 7:04 pm EDT
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Over the past several years, the term “food desert” has become prevalent in nutrition research and policy and is used to describe areas with a lack of access to fresh, healthy foods. The United States Department of Agriculture defines food desert as “urban neighborhoods and rural towns without ready access to fresh, healthy, and affordable food.” Low-income census tracts qualify as food deserts if they have “at least 33% of the census tract’s population live more than one mile from a supermarket or large grocery store or 10 miles in non-metropolitan census tracts.”

Areas defined as food deserts may receive federal, state, and foundation funding to improve their access, whereas areas that lack the label have greater difficulty in qualifying for the same opportunities. However, many policymakers do not take into account the complex relationship between healthy food access and consumption. They often focus on geographic proximity to food outlets as a precursor to funding, which may not be the best measure.

The relationship between access and consumption

Many studies on fresh food access and consumption focus on distance to and/or density of food outlets in an area. Similarly, most public policies increasing access to healthy food focus on locating supermarkets in food deserts. However, living closer to stores that sell fresh foods may be necessary but not sufficient to improve healthy food consumption among lower-income individuals. There is evidence that access to healthy food includes multiple factors, including transportation to food outlets; convenience of purchasing and preparing fresh foods; affordability, quality, and variety of fruits and vegetables; nutrition knowledge; and cooking skills. The limitations of defining access may be one reason for mixed results in studies assessing the relationship between healthy food access and consumption.

Geographic access alone might not increase consumption

Although it is advocated that increased access to healthy foods leads to increased consumption, the findings on the relationship between access and consumption are mixed. A study focusing on geographic proximity to grocery stores found that their presence in the community was associated with the probability of having a healthier diet.  Another study found that with each additional supermarket in a census tract, fruit and vegetable consumption increased by 32% among African American residents. However, a study involving over 5,000 young adults found that having geographic access to more supermarkets was unrelated to fruit and vegetable consumption. The fact that results from studies using geographic proximity to measure the effect of healthy food access and consumption have been mixed may indicate that other factors influence consumption.

Using qualitative research to dig deeper

Understanding that geographic access alone might not increase consumption, some studies have focused on other factors. Interviews with 28 low-income individuals in upstate New York revealed that participants had concerns about the store venue including store environment (such as safety, cleanliness, and customer service), quality, and price. In another study involving two focus groups with African Americans in Pittsburgh, residents perceived that supermarkets in their community offered poorer quality produce, less nutrient-rich foods, and poorer customer service than supermarkets in higher-income, “white” neighborhoods. In 2006, focus groups with community members in Minnesota revealed that major barriers to shopping in their community were cost, quality of food, and variety of food. Most qualitative studies point toward factors beyond geographic proximity in influencing access to healthy foods.

Where do we go from here?

Most qualitative studies continue to point toward factors beyond geographic proximity in influencing consumption of healthy foods, including fruits and vegetables, such as food quality and cost. However, quantitative studies are more likely to focus on distance to grocery stores and their relationship with consumption. So, where do we go from here? Fortunately, individuals focusing on access to healthy food are recognizing the importance of asking communities’ opinions about these issues before jumping in head-on. Instead of coming at the issue with, “We know how to solve your problem” we are beginning to ask communities, “How do you think this problem can be solved?

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