The Urban Environment’s Role in the Formation of Food Deserts as a Sociological Contributor to Obesity
Social and Behavioral Determinants of Health E.33.2355 – Fall 2008
December 11, 2008
Final term paper
Obesity is an epidemic in many developed countries, notably the
The urban environment is a broad term encompassing urban planning, urban development, and urban zoning. These factors affect living conditions such as “housing, employment, education, equality, quality of living environment, social support, and health services” 4. The built environment encompasses the transportation system and land use patterns, which together influence opportunities for healthy eating and physical activity 5. In densely populated urban spaces, public transportation can allow for easier mobility, thereby increasing access to stores that sell healthy food, health services, education, and employment 4. How unevenly quality of housing is distributed within a city affects health, and so does poor transportation, which makes access to health services and employment more difficult 4. Land use patterns can affect the existence of food deserts in an area, where communities’ access to healthy food options is limited. Insufficient access to healthy food translates into less healthy diets, which translates into higher rates of obesity – especially without adequate access to physical activity-friendly environments. This is particularly relevant in low-income neighborhoods, where not only are food deserts more likely to exist, but poor people are more likely to be uninsured and therefore more apt to let their health go unchecked until they have already developed a chronic illness such as obesity and/or diabetes 6.
There are several other characteristics of the urban environment that can affect health 4. The social environment can play a key role in health maintenance in urban environments. Social support can mitigate the impact of stressors and enable access to goods or services, and organizations that work to improve living conditions can have a positive influence on the social environment 4. Availability and access to health and social services are important determinants of health, as are demographic characteristics such as race. Risk of obesity in urban areas is affected by such living conditions as “housing, employment, education, equality, quality of living environment, social support, and health services” 4.
Municipal level determinants such as government, markets and civil society are noteworthy contributors to health as well. Governance can influence many sectors of health. Markets can act positively on health – such as the existence of farmers’ markets – but they can also be very detrimental to health, such as through the fast food market. In the urban setting, the availability of supermarkets is particularly salient. Civic society, which Vlahov et al. defines as “the space not controlled by government or the market where residents interact to achieve common goals,” can work to improve social capital (social support, community capacity) 4. Government, markets, and civic society can work independently as well as collaboratively to critically influence an urban community’s risk for obesity, and these relationships will be explored further in this paper.
I have compiled a wide array of research by using various methods. I conducted literature searches of peer-reviewed journals through NYU Library’s electronic journals and database search engines, finding articles in World Development, Nutrition Reviews, and Environment & Urbanization, to name a few. I informally asked my network of professionals in the field for their expertise on food deserts, particularly through the American Dietetic Association’s Hunger & Environmental Nutrition Dietetic Practice Group’s list-serve. In this way I found out about many resources that I would not have otherwise known about. Through my network, I also found out about and attended various nutrition and food security related meetings and conferences in New York City, of which I attended a Food Systems Network of New York City (FSNYC) meeting, a NYC Nutrition Education Network (NYCNEN) meeting, and a Manhattan Borough President Politics of Food Steering Committee meeting. I was unable to make it to the Politics of Food Conference that was organized by the Borough President’s Steering Committee because it conflicted with the NYCNEN meeting, but many of the speeches are available online, so I was able to watch them on my own.
At the FSNYC meeting on November 11, 2008, Geri Henchy from the Food Research and
The Steering Committee has had one follow-up meeting so far after the conference, where Scott Springer discussed the potential for introducing a bill to the city council for a new “Department of Food” in
There is much evidence that living in urban areas is associated with a greater prevalence of obesity, both in developed and developing countries. People in urban areas consume foods higher in fat, more animal products, more sugar, more food prepared away from the home, and more processed foods 3. In addition, urbanicity is traditionally associated with more service sectors jobs than agricultural jobs, and generally a more sedentary lifestyle. The urban effect exists even when income, food prices, and various other sociodemographic variables are controlled for, as found during a study in
Another observation is that although the average income in urban areas is generally higher than the average income in rural areas, this difference can be misleading, as a majority of the wealth is concentrated in the hands of the few urban elite 2. In addition, the cost of living is much higher in urban areas – especially
Land use and transportation, the components of the built environment, can significantly affect urban health. While land use and transportation systems should ideally work together to bring the most benefit to an area’s residents, in the United States they are structurally part of different levels of government: land use patterns are set by local governments and private developers, while transportation is run by the federal government. Therefore, increased coordination between these agencies is key to producing healthier environments 5.
Neighborhood design shapes “how people get from place to place (e.g., roads, transportation systems, bicycle and walking paths)…, where they exercise…, and the social norms and perceptions that impact how people use their neighborhoods (e.g., crime,…social capital)” 1. Decreased opportunities for physical activity contribute to the sedentary lifestyle that is found in individuals of lower socioeconomic status. Likewise, fear of crime and violence may decrease the likelihood of seeking outdoor physical activity in a neighborhood, especially for children whose parents perceive the area as dangerous 1.
The growth and expansion of highways by transportation authorities has pushed aside consideration for pedestrians and bicycle riders 5. However with the passage of the Intermodal Surface Transportation Efficiency Act (ISTEA), more pedestrian- and biker-friendly programs are being implemented, including providing over $400 for pedestrian and bicycle facilities, hiring a bicycle-pedestrian coordinator in each state, starting a $612 million Safe Routes to School program, as well as several other programs 5. Maryland has begun providing incentives for employees to live closer to work; London has implemented a “congestion pricing” program to discourage people from driving into certain areas at certain times by charging a fee; and “Location Efficient Mortgages” incentivize living in areas that are conducive to active travel instead of driving 5. Another idea is implementing voluntary travel reduction programs to educate residents on how to save time and money by cutting down on driving 5.
Most cities have high rates of inequality 4, and therefore in order to reduce the risk of widening disparities, community-specific inequalities must be accounted for. For example, there are neighborhood disparities in terms of obesity prevalence, with black neighborhoods having higher rates of obesity than white neighborhoods 1. African Americans are less likely to own a car in comparison to other races 6, which puts them at a disadvantage in terms of availability of transportation to get to healthy food vendors. Also, immigrants in a city like
According to Maya Wiley from the Center for Social Inclusion, urban zoning shows signs of segregation by race, especially in New York15. Out of the fifty largest metropolitan areas in the country,
While zoning ordinances of land use were originally established to improve public health by separating industrial activities from residential areas, the concern of property rights and separation of land usages eventually took over, leading to a separation of non-industrial establishments – such as stores and schools – from residential areas 5. The greater distances between destinations in a community, the less likely people are to walk or bike to get there, thus contributing to obesity through decreased physical activity. Yet “fast food restaurants aren’t usually labeled undesirable as a land use,” which means that they are allowed in low-income neighborhoods which have less restrictive zoning policies 5.
These policies brought about the existence of food deserts. Food deserts are areas “where access to healthy foods such as fresh fruits and vegetables is either limited, too expensive, or nonexistent. Inhabitants must opt for cheap and unhealthy foods based on whatever is available” 16. Food deserts exist both in rural areas – where the nearest supermarket may be miles and miles away – and in urban areas, where the number of fast food options far outweigh the number of supermarkets stocked with healthy choices, and the fast food choices are much more affordable than healthy foods. Urban areas are often characterized by a preponderance of corner stores which may not be adequately equipped with refrigerators, shelving, or advertisement messages for fresh fruits and vegetables; additionally, fresh fruits and vegetables may not be affordable or available 16.
The close proximity of fast-food and bodegas or convenience stores compounds the problem of increased distances to supermarkets that have affordable, healthy food. This is especially problematic for residents of low-income neighborhoods who are less likely to possess a car 17, as people who live far away from grocery stores and who do not have access to cars are less likely to travel distances to shop at them 6. In addition, fast food restaurants tend to be located around schools so that they can target their products to children and adolescents 5. Children in urban environments may be more likely to buy food at these establishments and bodegas on their way to and from school instead of eating a healthy breakfast in the morning, bringing lunch with them to school, or purchasing food from the school’s breakfast or lunch program offerings.
Meanwhile, “more affluent neighborhoods tend to restrict the number and location of [fast food] outlets through the formal land use planning process” 5, leading to even more health disparities between high and low-income neighborhoods. This is yet another contributor to the fact that areas with lower socioeconomic status have been shown to have less access to stores selling healthy food such as low-fat milk, high-fiber bread, fresh fruits, and vegetables 1.
Large chain supermarkets have the benefit of being able to offer lower prices and higher quality food options, but these benefits cancel out and contribute to health disparities if they are not accessible to low-income communities. Over the past 30 years, grocery stores have followed the white flight out of urban areas and established themselves in suburban areas, leading to an “urban grocery store gap” 18. They find it more economical to cut costs by buying in bulk and using large warehouses, which is easier to do in suburban areas 6. Research conducted by the
In order decrease the prevalence of food deserts in low-income communities, several interventions could be considered. These could include limiting the number of fast food stores and other vendors of unhealthy food by setting stricter zoning regulations, as well as giving incentives to supermarkets to locate in urban neighborhoods such as tax breaks and streamlined processes for obtaining permits 5. The development of public/private partnerships between governments and grocery stores could also be considered 17. However, adding more supermarkets to low-income neighborhoods in cities does not address the entire problem of food deserts, as will be discussed further on the following pages.
While large supermarket chains can successfully cut costs and consequently make foods cheaper, they have disadvantages as well. Food sold in large supermarkets that is shipped long distances has a diminished nutritional value, and there are high monetary and environmental costs of shipping, processing, and packaging 6. Also, supermarkets were designed for people with cars who could load up their cars with several days’ worth of groceries. They are not ideal for urban residents who have to worry about transporting the food items home.
In addition, supermarkets often run smaller stores out of business 6. Small stores are more likely to be near a community’s residential area, and therefore are more convenient for people who don’t own a car, can’t get a ride, can’t rely on public transportation, and can’t walk far distances. Single parents, people with disabilities, and the elderly all fall into this category 6. Yet, small grocers encounter a number of problems which makes it more difficult for them to provide fresh, healthy food. For instance, small grocers do not have the space or equipment needed to offer fresh produce regularly, normally do not carry a wide variety of produce, cannot buy in bulk quantities, and as a result must charge higher prices than chain supermarkets – up to 76 percent more 17.
The upshot is that cities should enable local citizens to obtain locally produced food. This can be done with urban agriculture, a phenomenon that is not new but was reintroduced to modern culture in the 1970’s when residents of
There is substantial evidence regarding the promise of urban gardens, and “the importance of urban and peri-urban agriculture and livestock keeping in sustaining the urban poor is being recognized globally” 2. Commercial food production relies on monocultures of crops that can prove devastating if the climate produces a poor harvest, as costs skyrocket with a decrease in supply. Urban agriculture can improve food security by increasing the stability of the nation’s food supply, as it decentralizes the food system and makes food available locally. It also drastically cuts down on food miles, improves the preservation of green space, and can benefit communities in terms of economic development 6. In addition, “micro-farming provides healthier produce” 6 and the nutritional quality does not decline with days of being transported from far distances.
Urban agriculture can be started in a number of ways. It can take the form of school gardens, where they can be used to educate children on skills that will last them for a lifetime. It can be entrepreneurial, where the food grown can be sold at local farmers’ markets. Community gardens are another idea, where the community members take charge through leadership and community organization. This can increase social capital, can have physical and psychological benefits, and can motivate youth and senior citizens to take a part in their communities 6.
Micro-farming has been used to boost the economy throughout
While access to healthy foods in low-income communities is essential to improving the obesity situation, it is not the only necessary component. Several generations of lacking access to healthy foods has led to a dearth of knowledge about how to prepare healthy foods, even when they do have access to them. Therefore, health education programs must be implemented in communities while simultaneously increasing access to healthy foods. There are various health-based efforts to shape the built environment, such as the World Health Organization’s Healthy Cities program to build relationships between public health officials, local planners and others; the Active Living by Design program to promote physical activity; Health Impact Assessments which state and federal governments could require for land use and transportation planning, and statewide health plans supported by the Centers for Disease Control and Prevention’s Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases 5. However, there are still many communities that have not been reached and still suffer from the problem of food deserts 6. National governments must adequately equip local governments “with the mandate, powers, jurisdiction, responsibilities, resources and capacity to undertake ‘healthy urban governance’” 2.
One way they could do this is by subsidizing seed programs to jump-start food sovereignty-based programs in low-income communities, such as the proposed Urban Agriculture and
Another promise for creating more equitable opportunities in the urban setting is to use financing schemes such as conditional cash transfers 2 and social welfare programs like the Supplemental Nutrition Assistance Program, which now allows users to shop at farmers’ markets 22. NYC DOHMH has come out with a Health Bucks Program where one Health Buck coupon will be given to each customer for every five dollars spent using food stamps 23. The Health Bucks can be used at farmers’ markets. This is promising because vouchers for fresh fruits and vegetables have been shown to increase consumption of produce in the past, as was shown in a study of the WIC program in
While this paper set out to examine the research linking obesity to urban environments in developed countries, the majority of studies I found were based in the
From the research, it is clear that there is indeed an urban health penalty felt by low-income communities across the
There are many interventions which can be considered when determining how to best decrease the effect of the urban health penalty and its associated risk for obesity among low-income communities. Changes can be made at the governmental level, such as: regulating where fast food restaurants are allowed to exist; working with the Department of Transportation and each state’s bicycle-pedestrian coordinator to expand and improve bicycle routes and pedestrian walkways; giving subsidies to vendors and community organizations that are willing to move into an area to sell healthy foods and educate residents on nutrition and cooking skills; and using social welfare programs to encourage low-income communities to purchase fresh fruits and vegetables. Governments can also take an even more radical step and develop a “Department of Food,” as is being considered in
It is also important to focus on community-level interventions because they help build social cohesion, which can go a long way in terms of actually bringing about change to a community. For instance, involving community members in the growing and selling of the foods they eat can give people a sense of pride and accomplishment while simultaneously improving their economic development opportunities, thereby increasing the chances that the program will be successful in the long term. Fortunately, there will be funding available for new interventions in the coming years in the U.S., as the 2008 Farm Bill has allotted $10.4 billion for urban agriculture and nutrition, aid for Historically Black Colleges and Universities, and a Healthy Urban Food Enterprise Development Program that will provide grants and technical assistance to communities to link farmers and grocery stores 26. One can only hope that this money will be used wisely by all parties involved.
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