Why a Lack of Grocery Stores is Trouble
"You are what you eat."
The quality of a person's nutrition has serious impacts on their health and well-being. Having a healthy diet reduces the risk of chronic illnesses in the long-run, improves energy that can be used for getting an education and making living, and it is even linked to improved long-term mental health.
Yet for the nearly 40 million Americans living in low-income low-food access areas in the US, poor nutrition is the norm. For some perspective, that's saying 1 in every 8 Americans does not live near affordable grocery stores.
What are Food Deserts
A food desert is a place where people have low access to healthy and fresh foods like fruits and vegetables, influenced by factors like income levels, travel distance to stores, and transportation costs.
The existence of a food desert disproportionately affects those with low-incomes. Long travel times due to large distances to grocery stores or poor public transit infrastructure that require those without a car to walk to a grocery store translates to a high cost in lost time, and more quantifiably, wages. Adults attempting to make trips to the grocery store with children are likely to face greater difficulty partaking in such trips.
For many, a convenience store may be the only alternative, where prices for food tend to be higher than grocery stores for a lower availability of fresh foods to purchase.
This is an issue not only in rural tracts of the country where the closest grocery store may be 10 miles away, but even in America's urban cores:
In some parts of the Bronx, there are more than 35 bodegas for every supermarket, according to the city's Food Policy Center.
The impact of food deserts cannot be simplified to an issue of "people traveling more to get healthy foods". Consistently poor access to healthy food effectively discourages buying healthy food in the long run. Saving time on every trip by simply going to a convenience store encourages these people to not pursue grocery store trips. The marginal cost of going the longer distance is simply not worth it, especially when Americans with lower income levels have less time to spare between work, childcare, and education.
Another interesting factor is the role that education levels play. One study by University of Chicago researchers indicates that consumer demand plays a large role:
"We find that about 20 percent of the income-related preference differences are econometrically explained by education and another 14 percent are explained by nutrition knowledge."
Individuals growing up with poorer access to healthy foods are also less likely to learn about the benefits of healthier and fresher foods as opposed to processed counterparts. These factors accumulate into vicious self-perpetuating cycles of residents in food deserts paying more for worse food which inevitably worsens health outcomes.
The US Department of Agriculture (USDA) has a convenient Food Access Research Atlas to visualize the extent of poor food access. Regions highlighted yellow are defined as follows:
Low-income census tract where more than 100 housing units do not have a vehicle and are more than ½ mile from the nearest supermarket,
or a significant number or share of residents are more than 20 miles from the nearest supermarket.
How Food Deserts Make Healthcare Expensive
It likely goes without saying, but poor access to healthier foods has strong correlations with higher rates of conditions like diabetes, obesity, and cardiovascular disease. Given the nature of food deserts, individuals are less likely to have affordable access to preventative and diagnostic healthcare services that enable spiraling health costs.
One study, in fact, found a 14% difference in risk of cardiovascular disease for those in food deserts versus non-food deserts.
Remember to visualize the healthcare impacts of food deserts in the context of poverty as a whole. Those most affected by food deserts are those with consistently lower incomes. Even if on Medicaid, the long-run medical and mental health costs associated with poor nutrition must be paid for by the Medicaid program to care providers.
Even worse, in areas that have not fully expanded Medicaid to give public health options to all of those up to 138% of the federal poverty line, there are millions who are simply unable to easily access healthcare coverage. The 11.8% of Americans who are uninsured are left to face poorer health or face massive out-of-pocket medical costs. For those ending up in the hospital due to unaddressed health issues stemming from poor nutrition, hospitals are likely to be on the hook to pay for health services that no one can pay for.
What Goes Around Comes Around
We've touched on social determinants of health (SDOH) before, but it's worth revisiting, because they are a great framework to understand why healthcare costs are out of control for the majority of Americans.
Poor socioeconomic factors have undeniable links to poorer health outcomes, and these translate into higher healthcare costs across the board. The pressures faced everyday by those with poor SDOH add up over years to the point that healthcare costs rise for entire swaths of the country.
These issues are not isolated to low-income America. The healthcare industry is uniquely interconnected. For the same reason that it's so difficult to reform completely, the increase in medical costs of one group of individuals means someone must pay for those costs by charging another group that may be able to pay for services at a higher profit margin.
Healthcare will not become cheaper until root issues preventing individuals from pursuing healthy lives are addressed, and it's as simple as that. This means nutrition education programs to convey the importance of healthy food, investment in public transit to get people to grocery stores, and incentives for local stores to carry healthier and affordable foods.