Earlier this month, the World Health Organization issued a call to action on diabetes—highlighting the need to prevent this devastating and costly metabolic disease. The Union of Concerned Scientists has also been focusing on preventing diabetes—but by fixing our broken food system.
Food access, diabetes, and race
What does food have to do with diabetes? Diets high in sugar, salt, and fat—and low in fiber, vitamins, and minerals, such as fruits, vegetables, and whole grains—increase the risk for Type 2 diabetes. Eating a healthy diet isn’t as simple as just going to the store and buying healthy food. But what people eat in this country is largely dependent on their access to various foods. Food access is complex, and can include the physical environment (geographic proximity, transportation to food retailers, and availability of healthy food); the economic environment (affordability of healthy food); and the sociocultural environment (cultural taste preferences). Race and income are highly correlated with healthy food access—and according to our new study—diabetes rates.
Consequences of unequal food access
Our latest report, “The Devastating Consequences of Unequal Food Access: The Role of Race and Income in Diabetes” shows that across all US counties, living near healthy food retailers is associated with lower diabetes rates. And the impact of healthy food on diabetes rates is even more pronounced in counties with above average populations of color. This is extremely significant given that communities of color are disproportionately affected by this disease. Native Americans (16.1%), African Americans (13.2%) and Latinos (12.9%) are nearly twice as likely as whites (7.6%) to have diabetes.
Food access and diabetes rates by county racial and economic composition
To estimate the relationship between food access and diabetes rates, we examined one kind of access to healthy food—geographic proximity. We looked at county-level data on retail food stores by county racial and economic composition. Counties were categorized as having either higher-than-average percentages of residents of color or lower-than-average percentages of residents of color and higher incomes or lower incomes.
We defined “healthy food retailers” as grocery stores, supercenters, farmers markets, and specialized food stores—all of which offer fresh and less-processed foods. “Unhealthy food retailers” were defined as fast food restaurants and convenience stores, which offer a more limited selection of food centered on highly processed convenience items. We compared access to healthy and unhealthy food retailers by county racial and economic composition and then we estimated the impact of this access on diabetes rates for each of the groups using linear regression models. Overall, our study found:
- Access, race, and income. Counties with higher-than-average percentages of residents of color have less healthy food retailers and more unhealthy food retailers. Lower-income counties had more unhealthy food retailers than higher-income counties.
- Healthy food access and diabetes rates. Greater access to healthy food is associated with lower diabetes rates. Across all counties, having an additional healthy food retailer per 1,000 people is associated with a 0.52 percentage point decrease in a county’s diabetes rate. This translates to nearly 175,000 fewer people with diabetes across the US.
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Fig. 1. (Click for full graphic.)
Proximity to healthy food has a bigger impact in communities of color. The impact of access to healthy foods is greater among counties with higher-than-average percentages of residents of color. Having an additional healthy food retailer per 1,000 people is associated with a reduction in diabetes rate that is three times larger in counties with above-average percentages of residents of color than counties with below-average percentages (Figure 1).
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Fig. 2. (Click for full graphic.)
Proximity to healthy food has smaller impact in lower-income communities. The benefits of access to healthy food is reduced in lower-income counties. Having an additional healthy food retailer per 1,000 people in lower-income counties is 2.5 times smaller than in higher-income counties (Figure 2).
- Unhealthy food access and diabetes rates. Greater access to unhealthy food is associated with higher diabetes rates. Across all counties, having an additional unhealthy food retailer per 1,000 people is associated with a 0.10 percentage point increase in a county’s diabetes rates. This translates to approximately 35,000 more people with diabetes across the US.
We need comprehensive public policy approaches to address complex issues
Similar to the World Health Organization’s recommendation that governments should ensure their people are able to make healthy choices, the Union of Concerned Scientists advocates that US public policies should take a comprehensive approach to addressing healthy food access. Solutions should be multi-level and include investing in infrastructure and coordination to get healthy food from farm to market; ensuring equitable access to public transportation, retail grocery and development opportunities across all communities; and providing culturally appropriate nutrition education for children, teachers and parents.
We should rework our nation’s broken food system to emphasize the goal of improved health and well-being for all. Policies that focus on equitable food access will move us closer to this goal.