Giving people access to healthier food isn’t enough

This one will be disappointing to a lot of you. Sorry. It’s a new study in Health Affairs by Steven Cummins, Ellen Flint, and Stephen Matthews:

National and local policies to improve diet in low-income US populations include increasing physical access to grocery stores and supermarkets in underserved neighborhoods. In a pilot study that evaluated the impacts of opening a new supermarket in a Philadelphia community considered a “food desert”—part of the Pennsylvania Fresh Food Financing Initiative—we found that the intervention moderately improved residents’ perceptions of food accessibility. However, it did not lead to changes in reported fruit and vegetable intake or body mass index. The effectiveness of interventions to improve physical access to food and reduce obesity by encouraging supermarkets to locate in underserved areas therefore remains unclear.

The rationale for food deserts goes like this: in many areas of the country, especially poor and urban areas, access to fresh fruits and vegetables is low. There aren’t many, if any, supermarkets, and so much of the food that’s available is processed or unhealthy. These areas are called “food deserts”.

The fix seems simple. If we open up supermarkets and make healthier food available to people, then they will buy it and be healthier. The problem is that this can be expensive and risky. Supermarkets can take up a lot of space, and can be expensive to run and maintain in the city. Understandable, private companies are sometimes reluctant to take the economic gamble on them. So food deserts remain. But if placing a supermarket in a needed area did a public health good, there might be an argument for some sort of policy to help companies make that leap. For years, many have argued that we need such policies to eliminate food deserts.

This study was a great first step. It took two food deserts and dropped a supermarket in one. Then the researchers watched to see what changed.

After at least six months, there were no significant differences overall in the purchase or consumption of fruits and vegetables in the two groups. In other words, providing people access to healthier foods is not enough. Access is not sufficient.

This will be disappointing news to people who have been fighting to eliminate food deserts. But it’s not all bad news. The study found that perceptions of accessibility to healthier food went up. And there were signs that those residents who did choose to shop in the supermarket might be making healthier choices. But there were too few of them to make a real difference.

Access may be necessary, but it’s not sufficient. Policies that are aimed at just eliminating food deserts may not work. More needs to be done.


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