Diabetes Forecast

Food Deserts Mar the Land of Plenty

By Lindsey Wahowiak , ,

Steph Larsen knows about farming. As a small farmer, assistant director of organizing at the Center for Rural Affairs, and a former columnist at Grist, an environmental newsmagazine, she's had her hands in the soil and has harvested healthy food. And yet, despite living out in the farm fields from Wisconsin to Montana, she can't necessarily go pick her dinner every night, and neither can her neighbors.

"You know what they farm? Field corn and soybeans [for animal feed], which no people eat," she says. "That is the irony. In rural America, you're surrounded by agricultural land or ranching land, but you can't grab a cow out of a field … and grill up some ribs that night."

Likewise, as manager of Dining With Diabetes, an education program offered through the North Dakota State University Extension Office, Megan Myrdal, LRD, knew her clients had questions about eating healthy food. But for many of them, the question wasn't what to eat but where to find it.

"They come from rural areas, and in many of those local communities they've lost their local grocery stores," says Myrdal, a licensed registered dietitian. "It's actually quite an irony: They have all this food around them [on farms], but they have limited access to fresh food. It's not the nutrient-dense fruits and vegetables we want to see people consuming on a regular basis."

Welcome to food deserts in America. No longer just the desolate urban blocks you might picture, food deserts can be found in every corner of the country, including the vast farmlands of the Midwest.

What's a Food Desert?

The U.S. Department of Agriculture (USDA) defines a food desert as a low-income area in which the closest supermarket is far away—a mile away in urban areas and 10 miles away in rural areas.

Now, are supermarkets the only places you can find healthful foods? Of course not, says Michele Ver Ploeg, PhD, a USDA economist who has studied food deserts. You can be certain, however, that a supermarket has a variety of fresh and frozen fruits and vegetables, low-fat dairy products, lean meats, and so on. The average corner store probably doesn't carry much, if any, of those, and prices are markedly higher.

The USDA also takes into account access to the stores. Not having a vehicle can be a serious obstacle to getting to the grocery store. That means you could be living on a street lined with fast-food outlets or surrounded by cornfields, and still be in a food desert. Make no mistake—while there is certainly food available, it is by no means the healthful, nourishing food a person needs to thrive. Particularly a person with diabetes. Could people get enough food to keep themselves from malnutrition? "Yes, of course, they can get some foods," Ver Ploeg says. "But do they have a whole array of healthy foods for a balanced diet? The alternative might be: Is it relatively easier to get bad food, compared to good food?"

Why Do Food Deserts Matter?

So you can't get to a supermarket regularly. Maybe it's because it takes two buses to get there, or because you live in the country and don't have a car, and a 20-mile round-trip bike ride with bags of groceries isn't feasible. If there's a burger joint on the corner or a farm stand nearby, shouldn't the responsibility be on you to get the nutritious food you need?

Maybe so, Ver Ploeg says, but that's an awful lot of pressure on an awful lot of people. About 18.3 million Americans live in low-income areas and are far from a supermarket. And while a good portion of those people live in households with cars, that's not a guarantee that each adult can get to the store to buy groceries. All told, the USDA estimates that between 1.8 and 6 percent of Americans live in food deserts.

That's unacceptable to Rep. Marcia Fudge (D-Ohio), who has championed the Healthy Food Financing Initiative, a legislative effort in Congress to reduce hunger and health disparities by funding grants and loans to support establishing local grocery stores in areas of need. Fudge cites one study that shows adults with no supermarkets within a mile of their home are about 25 percent less likely to have a healthy diet than those who live closer to supermarkets.

While Ver Ploeg says it's hard to tease out the effect living in a food desert has on health, she says multiple studies in cities and rural communities have shown a correlation between the availability of healthful food and diet-related health, specifically obesity, a risk factor for type 2 diabetes. Longer-term studies could back that up soon. The American Diabetes Association's recent scientific statement on the "socioecological determinants" of prediabetes and type 2 diabetes cited similar findings.

Many communities that are considered food deserts are home to many African American, Latino, or Native American people. These ethnic groups face a higher rate of diabetes than non-Hispanic whites do. The USDA cites studies showing that minorities in low-income neighborhoods are more likely to be food insecure (meaning they have difficulty getting a variety of or enough calories of healthful, affordable food). Without balanced nutrition, they are likely to be at further risk for developing obesity and type 2 diabetes. "For a lot of people who have health problems, who are elderly … having that local grocery store is vital," Larsen says. "Your health suffers if you're not getting the food you need, no matter who you are."

What Can Be Done?

Get Growing. If you can't buy fresh food locally, one option is to grow your own, says Thomas Blaine, MS, PhD, associate professor with the Ohio State University Extension Office. Blaine led two studies through the extension and found that in rural northeast Ohio, almost 75 percent of residents had a home garden. These people raise about 22 percent of the produce they eat throughout the year. That's a lot of trunk space and gas money saved. Higher-income households, families that have fewer children, and older people tend to garden less. Those who don't have the ability or space to garden on their own property still have the opportunity to get involved in community gardens—a major resource for people in urban environments who want to garden but may not have the space to do so. Community gardens often offer an educational component, which can be especially helpful for first-time growers.

Not only is gardening a good way to provide one's own food, but it also gets people moving and burning calories, Blaine says. "This serves a dual purpose when we're talking about health. It's good exercise, working the soil," he says. "The sedentary lifestyle is just as big a threat to American health as unhealthy foods."

Go With Tradition. Other organizations are taking cues from the past in order to create healthy communities in the future. Kimberly Morales Johnson, MPH, is a master trainer with the Diabetes Training Technical Assistance Center at Emory University in Atlanta and a consultant with Riverside-San Bernadino County Indian Health in California. Serving a largely urban American Indian population is difficult, she says—and with an estimated 70 percent of the population having prediabetes or type 2 diabetes, and the closest Indian Health Service hospital states away, eating healthful foods is a necessity. Yet gardening isn't an option. "It's a concrete jungle. There's no place to grow or cultivate or farm. And there's not a lot of access to fresh fruit and vegetables," Morales Johnson says. "It's hard for me, because those are my family members."

So Morales Johnson turns to cultural traditions to help guide her clients toward native foods. Eating regionally and seasonally means enjoying what's fresh and affordable now. Growing a cactus pad or pepper plants on a balcony or in an apartment window becomes an easy way to help feed a family. Setting aside foods that won't spoil for later use is also a key cultural lesson. When her clients do have access to a store, they follow their ancestors' lead, stocking up on nuts and seeds. "We've been doing that for thousands of years," Morales Johnson says. "We meal-planned for the whole entire winter, because we knew those acorns were only available for part of the year." Morales Johnson has seen her clients who follow these tried-and-true practices eating a better, more well-rounded diet. She's also seen her patients with type 2 diabetes and prediabetes move from high A1Cs to a more managed range.

Shop Locally. But gardening alone won't feed a family year-round. And if grocery stores aren't easily accessible, sometimes you have to bring the mountain to Muhammad, so to speak. Some retailers, including Target, Walmart, and CVS Caremark, have become more focused on opening smaller, food-rich stores in urban areas, according to a 2012 report in Bloomberg Businessweek. And in 2010, the Center for Rural Affairs issued a report on ownership models that work for opening and maintaining successful rural grocery stores.

Pam Budenbender gained some national attention in 2011 when she and her husband were featured on National Public Radio for opening the Onaga Country Market, the only grocery store in Onaga, Kan. In a town of 700, there may have been some skepticism about the store's survival, but two years later, Budenbender says it's going strong. "The community's been really supportive and we're doing well," she says. "It's vital to the community, I think. Without a grocery store, the community starts to die. The other businesses suffer and people move away. … There's not a value of living somewhere without good food. We all need to eat."

Dig In

Looking for a community garden near you? Or do you want to build one? The American Community Gardening Association can help you get started.

Local Harvest is an online resource that points you to the closest farmers markets, family farms, community-supported agriculture, and other sources of sustainably grown and raised foods in your area.

The Centers for Disease Control and Prevention has teamed up with American Indian and Alaska Native groups to promote its Traditional Foods Project, a grant program that uses traditional foods and sustainable ecological approaches to prevent type 2 diabetes.



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