By: Iris An
Take a moment, and try to picture the area where you grew up:
How far is it to go to a grocery store which provides healthy foods, such as fresh fruit, vegetables, grains, protein foods, and dairy?
If it’s a bit far, considering the car and gas price, how affordable is the driving?
How often can you go to grocery stores that provide healthy food
Now, think about your family’s diet habit:
How often do you consume healthy food? Is it daily, weekly, or seldom?
Food deserts are residential areas that provide poor access to healthful foods, and that largely consist of low-income residents who face transportation barriers to traveling outside their neighborhoods for full-service grocery stores.
According to the USDA’s food access research report, in 2017, nearly 39.5 million people — 12.8% of the U.S. population — were living in low-income and low-access areas classified as food deserts. Food deserts create constraints and limit the choices you can make, contributing to your eating habit and health outcomes. People living in food deserts have significantly higher rates of obesity and diabetes. Food deserts also contribute to rising chronic diseases among low-income and racial/ethnic minority residents.
In epidemiology and biomedical studies, the effects of food deserts are part of the social determinants of health (SDOH), which summarize the conditions in which people are born, grow, live, work, and age. These conditions are shaped by the unequal distribution of money, power and resources at global, national, and local levels.
Therefore, although it sounds like a question that should only trouble the CEOs of Walmart, Kroger, or WholeFoods, the distribution of grocery stores is indeed a social determinant of health. As the main source of healthy food, these grocery stores can affect people’s food intake, and therefore their health outcomes, depending on the location and distance to a particular residential area.
Dr. David Schlundt, Associate Professor of Psychology at Vanderbilt University, was focused on investigation and intervention of availability of healthful foods in food deserts in Nashville, Tennessee. His 2013 study identified 4 food deserts in Nashville, in which most were inhabited by low-income and racially and ethnically diverse residents, and attempted to increase availability of fresh fruits and vegetables, low-fat or nonfat milk, and 100% whole-wheat bread in Nashville’s food deserts.
Food deserts in Tennessee, picture from Dr. Schlundt used with permission
(Schlundt, D. (2022). Theories of Health and Behavior—Social Determinants of Health. PowerPoint Lecture, Health Psychology, Vanderbilt University, September 2, 2022.)
In our interview, Dr. Schlundt shared his observations on the developing nature of Nashville’s food desert since his research in 2013, and offered some directions for future governmental and social interventions.
(The interview has been edited for this article.)
IA: What are some factors that form a food desert? And how do these factors interact?
DS: There are three factors that together form a food desert: poverty, transportation, and lack of easily available healthy food. Transportation is important because with cars or public transportation, the poor people can have access to grocery store even though they are far from their home. But what often happens is that the price of oil and lack of buses prevent people from driving or taking public transportation to buy healthy food.
IA: Has the distribution of food deserts changed in recent years? What caused these changes? Is it just the grocery store companies, or are other business sectors/stakeholders involved in the changing nature of food deserts?
DS: In the past, large corporations tended to open new grocery stores in more fluent areas, where they could make more money. But recently, we can see some stores deliberately open in more mixed or less fluent areas, such as north Nashville, where there used to be serious problems with food deserts.
2009 geocoded food stores from online White Pages in Tennessee, picture from Dr. Schlundt used with permission
(Schlundt, D. (2022). Theories of Health and Behavior—Social Determinants of Health. PowerPoint Lecture, Health Psychology, Vanderbilt University, September 2, 2022.)
DS: Gentrification is another important factor, when renovation and redevelopment of the residential areas led to changing demographics of the neighborhoods. In the recent ten years, developers in Nashville have been buying up many old neighborhoods and pushing out a great amount of the lower-income population. For example, Germantown, around 1985, used to be filled with small and old houses, where some low-income black and white folks lived together. But in the early 2000s, developers bought the majority of these houses and renovated them into new condos or apartments with higher prices. So, a lot of the old, post World War II houses were rebuilt into two to four new homes, which were no longer affordable to the original population any more, and were sold to the richer people.
While the developers made money increasing the density of houses and extract profit from each home, the original low-income family cannot afford the new houses with the condensation they got from selling their old houses. In the end, the poor people had to leave their old neighborhoods and move farther away from the urban area, even into rural areas, where housing is less expensive.
At the same time, higher-income populations moved into the renovated neighborhoods, changing the demographic of the entire region. So the buying power of the neighborhood rose, grocery stores would be attracted to this area, and more healthy food would became available to the neighborhood. This is how the process of gentrification could reduce the food desert in Nashville.
IA: As a result of gentrification, although there may no longer be a food desert, it seems like these new stores do not really help the poor people, because they are forced to leave their neighborhood and away from the new grocery stores in the area. Is this correct?
DS: Yes, these reduction in food desert may not benefit the low-income population originally in this area, and did not lead to better health outcomes for people with lower socioeconomic status.
IA: So what happened to the low-income population who originally lived in food deserts? As they move away from the central urban area, would they end up moving into new food deserts?
DS: Unfortunately, there is no study investigating the consequences of gentrification and whether the poor population who was bought out from their old neighborhood could still gain access to healthy food. It is possible, however, that when they move to more rural areas, where grocery stores and other food outlets are distributed more separately, these people could be even farther from healthful food than before, and the adverse health outcomes from food deserts would become more serious.
For example, if they move outside of Ashland City, people might have to drive 10 or even 20 miles to get to a Walmart. Considering the gas price and the low income, would they drive this far or just buy food from a local convenience store, where there are no fresh fruits or vegetables? Many families in this case would give up the fresh and healthy food and just go with whatever the convenience store offers. Once again, poverty and transportation go together to limit people’s food choices.
IA: Are there any governmental intervention to solve this problem? How successful are these programs?
DS: There have been many governmental interventions, and some are quite successful. There is the Food SNAP, or Supplemental Nutrition Assistance Program, which provides food to households that meet certain qualifications referred to as eligibility criteria. Through an electronic debit card, Food SNAP offers subsidization to families that are not able to afford enough healthy food. This is a major effort of the government to reduce hunger, but there is no restriction on the type of food that people buy, so it does not necessarily promote healthier eating habits.
The Second Harvest Food Bank is another important program in Nashville. It is the largest food bank in Nashville that supports lower-income families with healthy food. Other non-profit programs include free meals for students at school and the “Head Start” project that provides food for preschool children.
IA: What is the most difficult barrier in fighting the problem of food desert and the resulted adverse health outcome in lower-income populations?
DS: Still, transportation is the main barrier for people to gain access to healthy food. If you live in New York or Chicago, there are ample bus lines and subways to send you to grocery stores, but here in Nashville, we do not have adequate transportation networks to connect people and healthful food stores.
Unfortunately, it is hard to improve transportation, as establishment of bus lines and stations require high investment and involve a longer time period.
Some recommended researches on this topic, accessible through Vanderbilt Library:
Gordon C, Purciel-Hill M, Ghai NR, Kaufman L, Graham R, Van Wye G. Measuring food deserts in New York City’s low-income neighborhoods. Health Place 2011;(2):696–700. 10.1016/j.healthplace.2010.12.012
Gittelsohn J, Rown M, Gadhoke P. Interventions in small food stores to change the food environment, improve diet, and reduce risk of chronic disease. Prev Chronic Dis 2012; 9:110015.
Larson, C., Haushalter, A., Buck, T., Campbell, D., Henderson, T., & Schlundt, D. (2013). Development of a Community-Sensitive Strategy to Increase Availability of Fresh Fruits and Vegetables in Nashville’s Urban Food Deserts, 2010–2012. Preventing Chronic Disease, 10.
