Exploring Food Access and Health Disparities Sarah Buila, Southern Illinois University, Illinois, USA

Abstract: I joined the wellness committee at the counseling center where I worked. We talked about how to increase our health habits and those of our co-workers. We organized lunch hour walking parties, got group discounts at a health club and decided to have a potluck luncheon in order to share our healthy recipes and sample the food. My co-workers talked about recipes that are low in fat, low in salt and sugarless. Often this meant artificial sweeteners and fat substitutes were part of their recipes. No one said anything about avoiding processed foods or eating less meat. No one said anything about eating more fresh fruits and vegetables, whole grains or organic and locally grown foods. It was at this very moment that I realized I was from a different planet. The planet I come from calls for a much different diet. The planet that I’m from has poor and affluent people alike who are obese. While in some parts of the world people are starving. Race, class, and gender influence health outcomes. What we eat is influenced by outside factors and I see people getting further away from the source of all food, the earth. Food is one common denominator in health disparities. On my planet there are dispar- ities in access to healthy foods. Part of the solution is related to broadening awareness. Coming up with solutions means coming up with new definitions about what is healthy food, and redefining our roles as health care practitioners/world citizens. Could it be that there is a diet that is not only good for you, but good for your global neighbors and the earth?

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Keywords: Diet, Health Disparities, Food Access, Global Health

THIS PAPER EXPLORES the relationship between health outcome disparities andaccess to food prefaced on the principle that diet is one of the most important factorsimpacting health. It is not recent news that there are health disparities according to racial/ethnic, gender, and socio-economic status. Much of the literature which ad-

dresses the problem of health disparities is focused on proving they exist. Identifying causes for these disparities is a much more complicated endeavor. If we are going to close the gaps between health disparities it is a worthwhile endeavor. Contributing to the difficulty in identifying causes is the multifaceted nature of human health and the individual and varying contexts which support (or don’t support) health and wellbeing. These facets include heredity, access to health care and disease prevention, lifestyle, stress, and diet. The focus of this article is on food and health conditions resulting from dietary choices and food availability.

Health Disparities Health disparities exist for many different vulnerable populations. Worldwide, poverty is a significant indicator of health disparities. People who are poor experience a higher prevalence of chronic disease, higher mortality rates, stress, and lower life expectancy (Mackenbach, Stirbu, Roskam et al. 2008; Chambers, Narayan, Shah, & Petesch, 2000). There are health disparities amongst indigenous peoples globally (Gracey&King, 2009) and racial and ethnic

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groups within the United States. For example, the United States Department of Health and Human Services (2003) has documented higher rates than whites, of cardiovascular disease, diabetes, some forms of cancer and kidney disease in African Americans, Hispanic Latinos, Native Americans, Alaska Natives, Native Hawaiians, and Pacific Islanders. Despite the fact that women live longer all over the world, women experience health outcome disparities in some parts of the world. The risks associated with child birth equalize life expectancy rates in poorer and less developed nations. Women are also more vulnerable to HIV infection in Sub-Saharan Africa, North Africa and the Middle East (United Nations, 2010). Health concern affecting underdeveloped countries essay

The Healthy Diet Connection to Health It is generally accepted that a healthy diet is part of what makes us healthy. Food consumption, for many is something that can be altered in order to improve health. Cardiovascular diseases are the leading cause of death worldwide. The World Health Organization (2004) states that 80 percent of deaths from heart attack and strokes could be prevented with healthy eating, avoiding tobacco, and exercising. Consumption of fruits and vegetables can help to prevent cardiovascular diseases and some types of cancer, diabetes, obesity and micronutrient defi- ciencies (World Health Organization, 2003). Related to food consumption, there is a worldwide obesity epidemicwith the number of overweight persons reaching over one billion. The amount and types of food eaten coupled with inactivity are the culprits. Many diseases are attributed to obesity. These include: type two diabetes, coronary heart disease, stroke, hypertension, pregnancy complications and some forms of cancer. Simultaneously, there are approximately 1 billion people who suffer from hunger; a diet of insufficient food quantity and nutrient rich foods deficient (Gardner, & Halweil, 2000). Malnutrition hits children in low-income countries the worst. It stunts their growth, and increases childhood mortality. Women with malnutrition suffer from iron deficiency which increases risk of maternal mortality and infants with low birth weight (Darnton-Hill & Coyne, 1998).

The Poverty Obesity Paradox Linkages between socio-economic status and obesity had been established years ago (Sobal & Stnkard, 1989). However, these connections vary between countries and within countries; there are gender variations (Wang, Y. 2001, Gnavi et al, 2000). The thought that anyone who is poor would also be overweight seems out of line. How is this possible? Poverty is relative and the poorest individuals living in the richest countries live in poverty compared to others in their country but those same individuals would seem rich if compared to others living in the poorest countries. This is not a complete explanation and it does not address the mechanisms at work making people overweight. A Gallup poll (Mendes, 2010) found an inverse trend between income and healthy behaviors of diet and exercise and a positive trend between income and smoking. Persons with lower income are less likely to report healthy behaviors than those with higher incomes. In the United states minority persons, except Asian Americans, were more likely to be obese (Flegal, et al,2002; Pleis et al, 2009). One can speculate realistically why income and healthy habits are related. For example, if a person must work long hours or multiple jobs, they may find it difficult to find time to prepare fresh foods. Fast food becomes an attractive option, in that it is immediately affordable and accessible. Also, income limits the geographic region people can call homewhich impacts

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where they can shop and what foods they will find available. Persons who are poor may not have the time, energy or land to plant their own garden.

Defining the Healthy Diet The United States Government Dietary Guidelines focus on balanced nutrition but some caution that these guidelines do not help prevent obesity in young adults (Zamora, Gordon- Larsen, Jacobs, & Popkin, 2010). Determining what constitutes an improved diet has been simplified to the increased consumption of fruits and vegetables (WHO, 2003). According to the World Health Organization (2005), 2.7 million people die each year as a result of low fruit and vegetable consumption. The United States Governmental Dietary Guidelines are in line with theWorld Health Organization’s recommendations about the importance of fruit and vegetables. Fruits and vegetables are at the peak of their nutritional value when just picked, so the fresher the better.

Food Security Food security is “defined as including both physical and economic access to food that meets people’s dietary needs as well as their food preferences” (WHO, 2011). Food security has to do with availability, access and use. That is, there is enough food consistently, it is afford- able and people understand the basics of nutrition. (WHO, 2011). While some parts of the world have issues around not having enough food, others have too much food available and resources to purchase the food, yet the outcome is still a poor diet. In developed countries, for example the United States, a kind of food shortage impacting especially low income in- dividuals, is what has been called ‘food deserts.’ According to the United States Department of Agriculture, a food desert is a geographic region where there is limited access to affordable and nutritious food. Kaplan (2009) found that poor neighborhoods have more small grocery stores and convenience stores, but less supermarkets. It is the supermarket that has more reliable, less expensive fresh fruit and vegetables. Others have also found more fast food restaurants and convenience stores within walking distance in low income neighborhoods (Moore & Diez, 2006). The United States Government Dietary Guidelines note that eating out increases weight gain and that one or more fast foodmeals per week is strongly associated with obesity (USDA, 2010). In a study of pregnant women and nutrition, proximity to super- markets was found to be positively associated with the quality of their diet (Laraia, Siega- Riz, Kaufaman, & Jones, 2004). Health concern affecting underdeveloped countries essay

Factors Influencing Access to Food The causes of food insecurity are varied. Food production is sensitive to fluctuations in weather conditions and the poorest countries have more difficulty coping with these changes. Food production and distribution is also influenced by economic and political situations. Even in-kind food aid can tip the balance of supply and demand, by depressing food prices and providing disincentives to farmers (Tadesse, & Shively, 2010). The causes of food deserts are debated to be either an issue of supply or demand or both (Bitler &Haider, 2011). It may be that the cost of carrying perishable fresh fruits and vegetables for small convenience stores in some neighborhoods is too high which can influence both supply and demand. Food

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shortages and food deserts have the most devastating impact on the most disadvantaged, the poor, women, children and persons who experience racial or ethnic oppression.

Dire Consequences As discussed, the human cost for poor nutrition is far reaching and is hardest hitting to vul- nerable populations. There are also far reaching implications to the health of the planet. The way that we produce and distribute food has a direct impact on global health. For example, diets with increasing meat consumption, amounts to more resources being used to produce the food (FAO-UN, 2009). Livestock production is also a contributor to greenhouse gases. If we compromise the earth’s ability to grow food sustainably, we will not be able to feed the growing population. “Without change, the global food system will continue to degrade the environment and compromise the world’s capacity to produce food in the future as well as contributing to climate change and the destruction of biodiversity” (Foresight, 2011, p. 10).

The Role of the Health Professional If health care professionals are going to address the issues of health outcome disparities, much needs to be done to address the disparities in food access, specifically access to fresh fruit and vegetables. Nothing short of a systemic change is required. Perhaps the first place to start is at home with personal habits. This will require learning what is most nutritious to eat and what will have the smallest detriment on the global system then transitioning personal habits accordingly. Next, is making a commitment to our patients and clients to support them in acquiring the knowledge they need to be able tomake healthy diet choices.When necessary, the health professional will be an advocate for increasing access to fresh food. This means supporting policies that increase agriculture production of food worldwide. This means supporting policies that encourage globally sustainable production and which simultaneously fight poverty. The implications go beyond the current political and economical reasons for food insecurity to a more global and sustainable effort.

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About the Author Sarah Buila Sarah Buila, PH.D. is Assistant Professor and Undergraduate ProgramDirector at the School of Social Work at Southern Illinois University, USA. She has been teaching courses in re- search, and health/mental health practice. She has over 16 years of experience in mental health practice and has long been interested in social justice issues related to mental health, race, religion, class and ability.

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