The Grocery Gap
According to the United States Department of Agriculture (USDA), 39.4 million Americans continue to live in communities where it is far easier for most residents to buy grape soda instead of a handful of grapes (1). Lower-income families have access to fewer supermarkets and other healthy food retail outlets that provide a wide selection of affordable, nutritious foods (2) (3). This problem impacts residents of both urban and rural areas across the country and is compounded by disproportionately higher rates of diet-related disease and the lost commercial vitality that makes communities livable and helps local economies thrive.
The challenge of healthy food access is notably persistent for those living in communities of color — the very same communities that are quickly growing in number and population share (4) (3). By 2044, a majority of Americans will be people of color (5). According to the 2012 study, Searching for Markets: The Geography of Inequitable Access to Supermarkets in the United States, African-Americans are 2.49 times and Latinos are 1.38 times more likely than Whites to live in neighborhoods without access to a full-service grocery store. Further, families living in a low-income block group are 2.28 times more likely to travel a greater distance to shop at a grocery store or supermarket than middle-income households (6). Historically, people of color have lived in, and continue to live in, the most under-resourced communities with the lowest-performing schools, poor access to transportation, inequitable access to affordable, healthy food and the furthest distance from quality jobs (7). Intentional and persistent disinvestment and discriminatory credit practices— e.g., redlining— in these communities have contributed to the deep racial disparities in health and economic outcomes (7).
For example, an analysis examining food access in low-income African-American and White communities in Detroit, Michigan found that low-income African-American residents traveled farther to the nearest supermarket as compared to their White counterparts, despite similarities in economic status (8). In Baltimore, Maryland, similar disparities exist, disproportionally affecting children and Blacks. A study by the Baltimore Food Policy Initiative and the Johns Hopkins Center for a Livable Future found that 30% of Baltimore’s children and 34% of African-Americans are living in areas with limited access to healthy food (9). The trend continues on the West Coast when in Los Angeles, California, predominately White neighborhoods benefit from nearly three times as many grocery stores as Black neighborhoods and twice as many stores as Latino neighborhoods (10).
At the same time, inequitable access to healthy food in rural areas, small towns and tribal communities is devastating families across the country. Even in agricultural centers where fruits and vegetables are being grown, residents may not have access to affordable produce (11) (12). Many of the communities lacking healthy food access identified by the USDA are in rural America, where 10 miles is typically considered a reasonable distance to travel to a grocery store, supermarket or other retail food outlet. However, it is not uncommon for the closest grocery store to be much farther away, and people living in low-income, rural communities typically have the farthest distances to travel to access healthy food (13). In tribal communities, these challenges also apply and are compounded by historical discrimination and hardship, which has negatively impacted American Indian sovereignty, health and economic outcomes (14). A study examining healthy food access in California’s tribal communities found significant inequities in access across tribal and non-tribal areas with tribal communities boasting far fewer healthy food retailers (15). Studies of tribal communities in Arizona, New Mexico and Washington found similar conclusions (16) (17) (18).
The healthy food access challenges in rural areas, small towns and tribal communities are unique. The USDA estimates that 2.3 million people live in rural areas that lack access to healthy food, 60% of whom are low-income (13). Smaller populations from which to draw customers, food distribution challenges, lack of transportation infrastructure and the aging of store owners are contributing factors as well (19) (13). Further, poverty in rural counties of the country is greater than in metro or urban counties, compounding the problem of healthy food access. Specifically, the South (region of the country) holds the highest poverty gap between rural and urban counties while Blacks and American Indians in those communities have the highest incidence of poverty (20).
The challenge of healthy food access in the most under-resourced communities across the country is exacerbated by poverty and diet-related disease. Without easy, affordable access to healthy food, families are forced to make difficult decisions about the food they eat. The recent evaluation of the dietary patterns of Americans, published in the Journal of American Medical Association, finds that while the overall dietary quality of Americans was poor, those with low socioeconomic status had worse dietary quality and the gap between socioeconomic levels grew between 1999 and 2010 (21). At the same time, a 2016 analysis of more than 18,000 households in more than 21,000 U.S. counties found that individuals living in USDA-designated “food deserts” had their odds of obesity increased by 30% as compared to those living in areas not designated as a “food desert” by USDA (22). The costs of these disparities are real. A recent study by the Milken Institute calculated the direct medical costs for diet-related disease in 2014 at $427.8 billion (23).
Healthy food retailers not only offer opportunities to purchase nutritious foods, but they also serve as economic anchors for further commercial revitalization, creating local jobs, generating tax revenues and capturing local dollars within the community, among other economic and community development outcomes. For example, it is estimated that 24 new jobs are created for every 10,000 square feet of retail grocery space, so a large market can generate between 150 and 200 full and part-time jobs (24). Attracting and incentivizing new or improved healthy food retail in communities of color and low-income, urban, and rural communities is an important component of a comprehensive strategy to revitalize disinvested areas by improving health and economic outcomes in the places that need it most.
The challenge and hardship presented by inequitable access to healthy and affordable food is well documented throughout academic research and gray literature (non-peer reviewed) and has moved to the forefront of community, civic and policymakers’ agendas. A shared recognition of the role that healthy food access plays in promoting stronger local economies, vibrant neighborhoods and healthy families has sparked support for healthy food financing to bring long-lasting investments in projects ranging from grocery stores to farmers markets, mobile markets, food hubs and corner stores.