Bobbi lives in northeast Pennsylvania, about 45 minutes from the Poconos. Her primary source of fresh food is a family-owned grocery store, with just four or five aisles. Bobbi says “the ‘produce department’ consists of three bins, and a cooler section with two or three shelves. We’re talking the very basics — bananas, oranges, maybe a few apples if you’re lucky. It’s not cheap either. I typically pay a dollar each for oranges, for example, but you can’t be picky because the selection is so limited. And in this area, produce can be especially scarce after the first frost hits. In winter, it’s pretty slim pickings.”
The nearest full-service supermarket to Bobbi is a Wegmans about 45 minutes away. “Their prices are actually fairly high, too, but at least they have a bigger selection,” she says. “When I have the time and can splurge, I make a trip there — but of course the stuff must be eaten fairly quickly, since produce doesn’t stay fresh very long.” Bobbi says she has learned to take into account that any meal requiring produce could be a major production because she needs to plan a special trip to a store that’s a fairly long trip. As a result, she rarely decides to whip something together on the spur of the moment.”
Now that Angel has a home, securing food is easier. The nearest full-service supermarket is not quite a mile away from her Las Vegas condo, and she can walk that distance or take the №56 bus. She also receives $120/month in SNAP benefits, and through an organization that supports people with HIV, she’s eligible for six to eight bags of groceries from Trader Joe’s each month. This type of aid goes a long way toward supporting Angel and her disabled husband and the 1-year-old grandchild she cares for most days. Still, food sourcing and meal planning occupy a considerable amount of free space in her brain.
Over 40 million Americans don’t have enough to eat and we want to know why. From redlining to the opioid crisis to the flint water crisis, we’re exploring why and what is making food insecurity worse in the United States.
AJ, a writer, lives on the far South Side of Chicago. She belongs to a high-income demographic not normally associated with food deserts. ”I make plenty of money and I have two cars, but until farmers markets sprouted up, fresh food was incredibly difficult to come by. It is infuriating.”
Neighborhoods like AJ’s, with no food access, are not an accident: These food deserts are the result of broader economic, geographic, social, and political forces that are influenced by systemic factors such as discrimination, global economics, and income disparity. Which is why when farmer Karen Washington suggested the term “food apartheid” in an interview with Guernica magazine earlier this year, many in the sustainable food movement began nodding their heads.
The most obvious contributing factor to food access is geography or, more specifically, proximity to a full-service supermarket. In rural settings, accessing the nearest full-service market may mean driving at least 50 miles round trip, requiring considerable time and gas money. Urban residents living without proximity to full-service supermarkets are faced with the choice of paying higher prices at smaller markets that are within walking distance, or taking the time and often public transportation to another neighborhood in order to shop at a full-service market. “When the time and transportation costs are factored in, food deserts are no longer merely an access problem but also an affordability problem,” says Pascale Joassart-Marcelli, director of Urban Studies at San Diego State University.
Social forces, like racism, have also played a key role in the creation of food deserts. For instance, Native Americans are twice as likely as white people to lack access to safe, healthy foods. One reason for this has to do with the history of the reservation system. The land on which reservations were created tended to be barren and resource deficient resulting in very few opportunities for economic solvency within reservations. Concentrated poverty, poor food access, and consequent chronic disease have arisen all from this original sin.
Systemic racism has also heavily influenced food access for African Americans. For example, a 2006 study showed that residents of predominantly white Northwest Washington, D.C., had access to one grocery store for every 10,000 residents while just across the Anacostia River, residents of predominantly black neighborhoods averaged one grocery store for every 70,000 residents.
A complex web of history, economic, and social policies are at play when it comes to many food deserts like those described by Angel and AJ.
Both as a response to the Great Depression and as a complement to the economic boom after World War II, the federal government sponsored programs intended to spur homeownership. These programs were, according to Sarah Strochak a research associate at the Urban Institute, “laced with discrimination, particularly in the form of redlining, or the process where banks avoid home loans based on community demographics.”
The practice is called redlining because lenders would draw literal red lines around predominantly Black neighborhoods and label them hazardous, while white neighborhoods were colored green and labeled “valuable.” These maps informed lending practices, and effectively segregated cities and towns throughout the country. With the help of the Federal Housing Administration (FHA) and other government-backed loans, white working-class families purchased homes primarily in the suburbs and accumulated wealth through homeownership. Meanwhile, people of color were systematically denied home loans and the attendant wealth accumulation.
Despite the fact that redlining was outlawed 50 years ago, de facto redlining and the racial wealth gap persist. Black homeownership rates have improved moderately in the years following the Fair Housing Act of 1968, but the rate peaked around 2000 and has been declining ever since, with Black people experiencing the most significant losses in homeownership of any demographic group during the Great Recession.
Systematic home-lending discrimination against people of color has accelerated the decay of inner-city neighborhoods. This, in turn, led to the withholding of capital investment, making it even more difficult for neighborhoods to attract retailers, such as supermarkets, further limiting access to food. In addition to economic and social forces, geopolitical forces such as globalization have also shaped the American food landscape, not only by restricting the flow of capital to low-income communities but by stripping once-thriving manufacturing communities of their economic base. For instance, when the American manufacturing sector was strong, small towns could support two or three stores, some of which stayed open 24 hours for customers on second and third shift. Now that many jobs have gone overseas due to globalization, there is higher unemployment and lower wages in these towns resulting in residents with less purchasing power forcing supermarkets to go out of business, again, further limiting access to food.
Food security is also largely a function of the ability for a community, a household, or an individual to afford the food items available at grocery store. “People who live in food deserts often shop at relatively more expensive small urban markets, and have a limited ability to purchase healthier foods (if they are even available) due to their limited income,” says Fernando Bosco, Marcelli’s research partner at SDSU. For instance in Southeast San Diego — a neighborhood Bosco and Marcelli have studied and one that is designated as a food desert by the USDA — a non-organic apple in a grocery store is 89 cents while a 7-Eleven on the next block sells a smaller apple sitting next to two rotting bananas in a basket by the register for $1.29.
And while stores may carry healthy food, finding it in small markets and convenience stores — even liquor stores that accept SNAP benefits — may be difficult. In such stores, shoppers are greeted by racks of chips, processed pastries, and sugary sodas making it easy for them to get lost in unhealthy choices and never find their way to — or have money leftover for — the healthy choices.
And it’s not just food placement or money spent at the register that factors into food accessibility. Dr. Hillary Seligman, a food-access researcher and founder of the EatSF healthy food voucher program, points to the time it takes to prepare food, the refrigeration required to store perishable food, the appliances to cook it, which families don’t have if the utilities have been cut off. Seligman concludes that “it would take a 70 percent increase in a low-income person’s food budget to afford the five servings of fruits and vegetables recommended by the USDA’s food pyramid.”
In addition to creating the necessary conditions for food deserts, researchers have found that residential segregation also increases the prevalence of fast food restaurants. This environmental context places residents in a double bind contributing to a nationwide health crisis stemming from diet and food access.
It’s not just food placement or money spent at the register that factors into food accessibility. It’s also the time it takes to prepare food, the refrigeration required to store perishables, the appliances to cook it, which families don’t have if the utilities have been cut off.
Darryl is a Vietnam veteran living in halfway house in a predominantly Black neighborhood of Seattle. He lost his left leg from the kneecap down and lost all five toes on his right foot, not on the battlefield, but due to his diabetes. “The doctors and nurses tell me I need to change my diet, and I’ve tried, but I like what I like to eat, and I can’t afford no fancy lettuce anyway.”
Along with diabetes, obesity is also another facet of the country’s preventable health crisis. Obesity rates have risen steadily across all demographic groups in the U.S., however, the highest rates occur among the most disadvantaged groups. Thus, segregation sets in motion a vicious cycle of food insecurity that changes people’s dietary intake that over time predisposes them to chronic diseases like obesity and diabetes. Seligman adds, “People in poor health are less able to make the dietary changes needed to improve their health. Therefore their health continues to deteriorate, and when they get sicker that puts pressure on their household budget associated with reduced employability in combination with out-of-pocket medical expenses.’”
Segregation fixed to racism is not the only systemic force shaping the food landscape. In recent decades, a large share of income gains in the U.S. flowed to a relatively small percentage of high-earning households. The 2014 Gini Index — the best measure of income inequality — indicates that the gap between America’s rich and its poor is significantly wider than most countries. Numerous studies also provide evidence that income inequality is associated with high rates of physical and mental health problems, and social problems such as gender inequality.
In June 2016, the International Monetary Fund warned the United States that its high poverty rate needed to be tackled urgently by raising the minimum wage to offset income inequality, and by offering paid maternity leave to women to encourage them to enter the labor force. And in 2017, the United Nations special rapporteur on extreme poverty and human rights issued a report on the effects of systemic poverty in the United States, and sharply condemned “private wealth and public squalor” in the U.S.
Food insecurity as a human-rights issue hits women and children especially hard, given that female-headed households are disproportionately poor and women are typically the primary food shoppers and preparers, and the child bearers and caregivers. In addition to previously mentioned obesity and diabetes, food insecurity has been associated with stress, anxiety, and depression in women.
Food insecurity also correlates with poor pregnancy outcomes, including low birth weight and gestational diabetes, due in part to nutrient deficiencies of the mother. Three potential reasons why are: nutrient demands are higher, the effort required for food preparation may be more difficult, and pregnant women may be obliged to leave the workforce, especially in later pregnancy, which leads to further financial strain. A postpartum survey to analyze income levels and hardships before or during pregnancy showed that approximately 35 percent of poor women and 20 percent of near-poor women reported food insecurity, compared with 8 percent, 4 percent, and 0.6 percent of women in the successively higher income groups.
Food insecurity in pregnant women also has negative consequences for the child. In a random sample of women receiving welfare, food insecurity was significantly associated with a low-birth-weight delivery. Another study of maternal food insecurity was associated with an increased risk of certain birth defects, such as cleft palate, spina bifida, and anencephaly. For HIV-infected pregnant women, poor nutritional status that can result from being food insecure may increase the risk of transmission of HIV to the child.
Of the 40.6 million Americans living in poverty, Feeding America reported that in 2016, 13.3 million of them were children. Additionally, many of the neighborhoods these children lived in lacked access to basic produce and nutritious food.
The long-term implications of food insecurity for children are equally daunting. Seligman points out, “If we aren’t sending kids to school hungry, they are much more likely to achieve in school, graduate from school, and become long-term income earners themselves.” To mitigate the physical and mental health consequences of food insecurity on women and children, safety nets have been put in place such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and The Supplemental Nutrition Assistance Program (SNAP, or food stamps), with women making up 63 percent of adult SNAP recipients. “The basic goal of SNAP is to reduce food insecurity in the U.S. and it is extraordinarily successful at doing that,” says Seligman. The US Department of Agriculture confirms this observation indicating that 8.4 million people, including 3.8 million children, were lifted out of poverty in 2015, resulting in a 17 percent reduction in the poverty rate.
Depending on the state, the average monthly benefit for SNAP recipients ranges from a high of $228 in Hawaii to $105 in Wisconsin. Unfortunately, this average has steadily decreased in recent years and will decrease again if cuts proposed by the Trump administration are passed by Congress. The budget for Fiscal Year 2019 includes a 21.5 percent cut to SNAP, and a total of $213 billion less over the course of ten years. Mark Ryle, CEO of Project Open Hand (POH), a member of the Food is Medicine Coalition argues that all a reduction of SNAP benefits does is put greater pressure on other programs to fill the gap. And the gap lies most largely with the most vulnerable populations, young kids and seniors.
The right-swinging political pendulum would also cut through funding for 13 major housing, health, and social services block grants by one-third. Rather than signaling a commitment to building pathways out of poverty for families in low-income communities — a Trump campaign promise — the president’s budget proposals would result in further disinvestment from these communities, placing more families at risk for food insecurity.
Proposals for how to eradicate food deserts tend to focus on geographical access, however, this focus is too narrow, and may misdirect policymakers to favor external interventions. Seligman says, “Plopping down a grocery store in a low-income neighborhood, while it may solve the accessibility problem, does not necessarily solve food insecurity.” In order to solve the conjoined problems of food deserts and food insecurity, Bobbi’s affordability and time constraints must be addressed, as must Angel’s lack of food storage, and Darryl’s desire for food sovereignty.
Currently, innovative programs such as POH in California are piloting more holistic approaches that go beyond the problem of access. In partnership with California’s Medicaid office, POH, seeks to lower the $34 billion per year the State spends on preventable hospital admissions — a number amount grows by 10 percent per year. The prevention-based partnership targets individuals going into the hospital numerous times for preventable reasons. Participants leave the hospital with three days worth of food. Then, within 48 hours of discharge, a case manager structure comes to their home. For 12 weeks participants get 100 percent nutrition that is specifically tailored to their diagnosis and to their medication.
Project Open Hand makes 4,500 meals from scratch every day and delivers those once a day if needed if recipients lack food storage. There is also a nutrition education component that teaches participants new habits and how to make these meals out of groceries with the goal of titrating them into a grocery program. The case manager then walks with participants in their communities to identify stores where they can obtain food locally, food that will actually match up with the participant’s taste and particular nutritional needs. “The numbers won’t argue with the science,” says POH’s Ryle. “Once we prove the model works there will be a return to the state which is how they’re looking at it. We serve two masters, the state’s desire for a return on investment, and the greater social good.”
Lastly, ignoring small and ethnic markets, as the concept of food desert does, reduces the range of solutions for improving food security and thereby reproduces an uneven food landscape that is divided along the lines of race and class. According to SDSU’s Bosco, “policy initiatives that support ethnic markets, and provide assistance to encourage the sale of fresh produce, may be an efficient and equitable way to increase food availability, promote culturally appropriate foods, and bolster local small business.”
Originally published at www.damemagazine.com on September 6, 2018.