CAP Research Seminar Final Review of Literature

Shindel, 2019
Lucy Martin, Louis Rosenberg, Lila Chafe

How can state, federal, and local governments work with communities that are food insecure to promote
accessibility to nutritious food?
71 year-old Toni Lawson lives in DC's Ward 8. Her neighborhood, a predominantly poor area in
Southwest DC, has been her home for over 30 years. A retired employee from the insurance industry,
Lawson's everyday life doesn't seem all that different from another person anywhere else in the country.
Yet, for Lawson, a quick grocery store run, that takes the average person about fifteen minutes, is an all
day event. She walks to the bus stop and takes two different city buses to reach a grocery store two miles
away. Her commute totals 40 minutes each way. At age 71, this is no easy feat. But this isn’t a new issue
for her. For the past 30 years that Lawson has lived in her neighborhood, the closest grocery store has
been miles away. A lower income neighborhood, with no access to a car and a grocery store over half a
mile away, Lawson’s situation has been defined as a food desert.
Toni Lawson is not the only person who suffers from these circumstances. She is one of 23 ½
million Americans who live in a neighborhood that the USDA calls a food desert. That is equivalent to
over 2% of all U.S. households. A shocking amount of people all across the country, especially people in
urban areas, live in communities that do not have convenient access to healthy food in the form of a
grocery store.
Food insecurity is a complex issue involving many different aspects and intersecting policy. Food
deserts are represented not only by a lack of food, but a lack of fresh and varied produce. The
communities affected by this phenomenon often suffer from diet related diseases, and develop unhealthy
eating habits. For many, food is not available at an affordable rate, and local bodegas or convenience
stores substitute the healthier options that only exist miles away. The accumulated effects of food
insecurity perpetuate cycles of poverty, and create inescapable traps of unhealthy eating and disease.
Urban communities struggle from a new concept, food swamps, which is the inundation of unhealthy
foods in a concentrated space. Without access to information and healthy options, communities are
powerless to reform their food environment and rise up against the overbearing food industry.
Food insecurity has been seen to target low income communities in both rural and urban areas.
Focusing on urban locations, Black and Latinx populations are primarily affected by poverty, and in turn
are more susceptible to food insecurity and dietary diseases. Recently it has been given more national
attention due to Michelle Obama’s campaign to eradicate food deserts. As the food industry monopolizes,
there is increased creation of food swamps, spreading the crisis throughout American neighborhoods. It
cannot be seen as an isolated aspect of policy and societal structure, as transportation, homeownership,
access to health care and information, education, land ownership, and economic security all has an impact
on food access.
This crisis affects all types of communities. Anacostia and Baltimore, areas close to home, both
suffer from food insecurity. Originally, our research was focused on local food environments, but
eventually we expanded to include locations that have been affected from interventions. The influx of fast
food stores has had a dramatic effect on health and obesity within the past decade. Food production is
continuously degrading, and low income neighborhoods are the first to suffer from the repercussions. The
food crisis must be addressed before communities become dependent on unhealthy diets. An evaluation of
research and interventions is vital to honoring and protecting each community’s right to healthy food.
Throughout the last decade, many interventions and projects have tried to determine the factors
causing food deserts and the ways to bring the communities out of poverty. Studies have concluded that
introducing a supermarket into a food desert does not create enough change to solve the crisis, and other
local reforms must take charge to create a lasting food environment. It is difficult to determine the
correlation between location and obesity, and due to this, many studies have devalued the importance of a
food environment and geographic location. New studies are concluding that food swamps are controlling
the balance of food access, and concealing the disparities and injustice that communities face.
There are multiple solutions tested to aid people in food deserts. Communities without access to
healthy food often suffer due to structural barriers limiting community control of resources and
supermarket intervention. In this review of literature, we explored the current structures in place or lack
thereof causing food insecurity, it’s effects on low income communities and the actions that should be
taken to solve the problem.

Causes
Food insecurity has been a prevalent cause of current health conditions and injustice for years, but
before intervening to fix the system, one must understand the underlying patterns creating food inequality.
When examining a topic related to health, and especially the health standards of oppressed peoples, it is
impossible to avoid the intersecting factors such as economic rights, education, access to aid and
information, and inclusion in reform groups. Research has shown correlation between multiple societal
structures and food access, and it is important to evaluate the composite effect that historical injustice has
on current equality. Apart from structural oppression, “food deserts ‘are constructs of our economic
political system that favors profits over people’” (Cook). One’s neighborhood predetermines one access
to food, and class and race has further effect on the access to additional resources or social mobility. For
this reason, the term ‘food apartheid’ is becoming increasingly relevant to the framework of the issue.
Economic Oppression
Beyond class, it is clear that economic oppression caused by racism has a profound effect on the
well being of certain demographics. A research study cites the percentage of Black and Latinx people
facing food insecurity at “25.1% and 26.2%, respectively, while the same statistic for the
Caucasian/White population was approximately 13% during the same period” (Elsheikh and Barhoum).
Structural racism causes poverty, which furthers food insecurity and allows diets and diseases to emerge
among underserved communities. Multiple studies have used homeownership status, poverty level, race,
age, transportation access to evaluate the effects of food insecurity, and revealed the multiple pressures
acting against affected communities. The disparities in access to resource is correlated to historical and
current institutions in society, and “a primary reason for these disparities are ostensibly race-neutral
policies espoused by the government that have had racialized consequences” (Hussain). Residents
deprived of economic rights over centuries are less resilient and unable to regain health patterns and
economic power.
Income instability and homeownership greatly affects one’s lifestyle, and for many, purchasing
healthy and expensive produce is not possible due to low wages and a poor social security network. Food
insecurity exposes many social issues such as unequal access to healthcare and neighborhood segregation
that are easily ignored by people with privilege and power. Clearly, those without healthcare struggle to
make ends meet, and the effect of food insecurity can be detrimental to the costs of living without aid.
When asked how one copes with a low budget and food needs, the study concluded that “more than 50
percent receive help from family or friends; 79 percent purchase inexpensive, unhealthy food; 40 percent
water down food and drinks to make them last longer” (Weinfield et. al). These steps are a result of long
lasting economic deprivation, and residents become dependent on mechanisms meant to temporarily
replace their lack of food.
Oppressive Structure
Historical policies allowing for neighborhood segregation and reduced access to federal, state and
local aid is also a leading cause in the prevalence of food insecurity. Homeownership and loan restriction
was a primary tactic used by banks and governments to segregate neighborhoods and limit social mobility
for African American residents. According to the Haas Institute for a Fair and Inclusive Society, “African
American families were unable to access the same low-interest home loans as white families due to
government sanctioned redlining, restrictive housing covenants, and discrimination, and were left
stranded in the cities” (Hussain). The disregard toward Black families forced them to stay in lower
income neighborhoods, ones that lacked adequate funding and accessibility to healthy food. Access to
varied produce can reform one’s diet, but without the readily available food, many are forced to adapt to
the options available to them. This is where food swamps are introduced. The cycle of food insecurity is
furthered by medical concerns resulting from unhealthy eating and restricting the victim financially.
Feeding America conducted a study concluding that in “33 percent of [household participants], a member
has been diagnosed with diabetes, and in 58 percent of households a member has high blood pressure,”
additionally, “in 23 percent of households, no one has health insurance coverage, and 60 percent of
households have unpaid medical bills” (Weinfield et. al). The data implies that among people struggling
from food insecurity, an overwhelming amount have health concerns acting as a cause and effect of food
insecurity. Without adequate aid or health care, these populations will be forced to choose between food
and care, putting their health and the health of those around them at risk. Other structural issues can be
attributed to causing food insecurity to disproportionately affect Black and Latinx neighborhoods.
Additionally, unequal distribution of resources and funding can further the suffering felt by
individuals trapped in food deserts. Due to the loop of food insecurity, “food deserts are prevalent in areas
where other racialized policy outcomes are visible, such as areas impacted by home foreclosures, lack of
funding for public schools, lack of adequate public transportation, and high levels of health disparities”
(Elsheikh and Barhoum). Although the victims of food insecurity still have the ability to choose healthy
food, their choice is severely limited from economic instability and food availability. The food industry
has total control of the distribution of nutritious and accessible foods, and without reforming the social
structure of distribution, communities will continue suffering. It often values profit over people, creating
prices and advertising targeted towards low income communities while worsening health. The dangers of
living in a monopolized food swamp are clear, and to many, the causes are easy to ignore. Policymakers,
reformers and the food industry are ignorant of the many needs of a community, and their indifference is
exposed through the obvious injustices.
Supermarket Redlining and Distribution of Resources
Marginalized populations are indirectly removed from healthy food access due to supermarket
redlining. White flight and the promotion of segregated lifestyles led to the food industry’s gentrification,
and removed healthier options from low income and primarily Black and Latinx neighborhoods. There is
minimal incentive for supermarkets to open in low income neighborhoods, and it is easier for a
supermarket to profit in a middle or high class neighborhood because of policy dissuading the importance
of distributing food equally. According to the Johns Hopkins Center for a Livable Future, “cities typically
offer limited incentives to the supermarket industry to locate in low-income areas. Most chain
supermarkets will not consider opening in low-income neighborhoods, as community need is not a core
criteria for industry site selection” (Santo et al). Supermarkets looking to profit will not find a location in
the city, but by following the money instead of need, they are creating a desert for those who do not have
power over the monopolized industry. Food retailers select neighborhoods promoted by local and national
governments as safe and profitable. The distribution of grocery stores reflects the patterns of segregation
along neighborhood boundaries. ​Not surprisingly, cities and towns with high percentages of food insecure 
residents are those suffering discrimination and economic oppression.  
With the pressures faced by supermarkets and food retailers, it can be too difficult to invest in 
communities already struggling from infrastructure and funding issues. Historically, food segregation was 
prominent, and ​“not only did retailers move outside of Black neighborhoods, perceiving the
neighborhoods to be economically ‘unstable’ and ‘blighted,’ but… competition from the suburban chains
caused some city grocers to close… identifying them as declining markets” (Hussain). Once the
introduction of supermarkets into food deserts is possible and promoted, communities will not have to
rely on unhealthy food or prioritizing their meals. Although incorporating food deserts is not the only
intervention required, food retailers must be given incentive to aid historically oppressed neighborhoods.
The pricing and variety of food at stores within food deserts restrict residents the power to choose
healthy food for their family. Neighborhoods identified as food deserts have countless burdens degrading
their health and furthering food insecurity, and without reform to break the cycle, generations will
develop extremely unhealthy diets. New York Law School Racial Justice Project concludes that “minority
communities are more likely to have smaller grocery stores carrying higher priced, less varied food
products than other neighborhoods” (Hussain). Once in a food desert, individuals are trapped into a cycle
of food insecurity, and the lack of resources strips power from neighborhoods deserving justice.
Diverse studies questioning the correlations between economic and racial demographics and food
insecurity have established the complex intersections of public policy and the formation of food deserts.

Effects

Solutions
While there is much consensus among the literature about the lack of access to nutritious food in
low income areas, there is less clarity and concurrence when it comes to effective solutions. With
different research focuses and varying locational focuses, the research papers and studies came to
different conclusions for the necessary solutions. Yet, when analyzed closer, the distinct solutions share
commonalities and can be combined to create a comprehensive solution.
Current Initiatives
Over the years, as the obesity epidemic has grown and food desert areas have continued to suffer
from diet-related health issues, private organizations and small programs have popped up to provide help
to these communities. Programs like The Food Trust, Active Living by Design and Healthy Eating Active
Living lead projects such as improving dietary choices in schools and getting more fruits and vegetables
in corner stores, in order to change the food environment in low income communities (Sallis). There are
many organizations and programs all over the country that have stepped in and made needed changes in
suffering areas. One study done by James Sallis and Karen Glanz acknowledged the importance of these
programs in the present and how they can help in developing future solutions. They write,“These diverse
intervention models are building experience in environmental and policy change, are providing
opportunities for research and evaluation, and, we hope, are offering lessons that others can use to
disseminate effective approaches on a wider scale” (Sallis). Unfortunately, these programs can only reach
so many communities and often have short term results. The current initiatives to fight food insecurity
have benefited many communities over the years but there needs to be more involvement in the fight to
provide a more effective solution.
Increased Access
The overwhelming conclusion of just about every piece of literature was that increased access
relates to healthier eating habits. A comprehensive study and research paper done by The Food Trust and
Policy Link identified that many people in low income areas do not have access to nutritious food but
having access to quality supermarkets corresponds with healthier eating. Their paper, written by Allison
Karpyn and Sarah Treuhaft, examines who is affected by food insecurity and how it affects those
communities. The authors include many studies and cite numerous pieces of data. Their reported findings
were that 1) low income areas, communities of color and rural areas suffer the greatest from a lack of
accessible food, 2) better access corresponds with healthier eating, 3) access to healthy food is associated
with lower risk for obesity and other diet-related chronic diseases and 4) new and improved healthy food
retail in underserved communities creates jobs and helps to revitalize low-income neighborhoods
(Treuhaft). Another piece of literature concurs with the idea that increased access is key in solving food
deserts. The report, written by James Sallis and Karen Glanz and published by Milbank Quarterly, cites a
study that “found that African Americans' intake of fruits and vegetables was significantly higher when
they lived close to a supermarket. Accordingly, the availability of supermarkets in neighborhoods was
associated with a better-quality diet.”
One needed solution to food insecurity is providing a way for people to buy nutritious food.
Various pieces of literature point out the importance of having neighborhood grocery stores and putting in
new retail stores in low income communities. The Food Trust report suggested that supermarkets and
grocery stores should be encouraged to build in needy areas by providing tax incentives. The paper stated,
that “Cities have many policy tools they can use to incentivize and promote healthy food retail including
land use planning, zoning, economic development and redevelopment, and nutrition assistance”
(Treuhaft). It goes on to explain that some areas have already done this: “Cities can help overcome these
barriers by providing publicly owned land for food retailers, helping with land assembly, and identifying
and marketing sites for grocery store development. Several cities have conducted internal assessments to
understand how their agencies and departments can foster healthy food retail in underserved
neighborhoods.” Increasing the number of grocery stores in low income areas is a significant part of
solving the food insecurity crisis. Incentivising the grocery stores is an effective way of accomplishing
that.
Education and Encouragement
While studies have shown that increased access tends to lead to more nutritious eating habits,
other research points out the need for collateral programs to educate community members about healthy
diets and healthy living. Some studies show that increased access to food does not directly lead to
healthier eating habits. To bridge the gap between having the availability of food and knowing how to use
that availability to the full potential, education on healthy habits is very important. Many people in low
income areas grow up with poor eating habits and wouldn’t choose to eat anything healthy. It takes being
taught which food is healthy and how it impacts your health and encouragement to follow through with a
new diet, in order for a person to take full advantage of the new accessibility to food. Programs such as
the ones in schools and in health clinics are examples of food education.
Community Involvement
One key part of an effective solution is community engagement and involvement. The members
of the community are who the solutions are for and who should benefit from them. If they are not
involved in the process of changing the food environment it is less likely that they will benefit from the
changes. One research report states, “Even though scientists and public health experts may determine that
environmental change could help reduce obesity—for example, by restricting the number of fast-food
restaurants in a disadvantaged neighborhood—the residents may regard such a regulation as punitive or
stigmatizing because they depend on cheap, convenient food sources and lack reliable transportation
options” (Sallis).
Involving community members is also a positive way to encourage all to participate in changing
unhealthy habits. A report by Johns Hopkins Center for a Livable Future, which focuses on the
socioeconomic and environmental factors that lead to food insecurity in the Baltimore area, presents this
idea. The authors write, “Family and community members served as sources of observational learning, as
seeing others’ adverse health outcomes from diabetes motivated some to making healthy choices. Family
and community members also provided knowledge, skills, and support to help individuals with diabetes
adopt and sustain a healthy diet” (Santo). Engaging the community allows members to provide input and
truly feel connected when the changes are made. The more involved the community is the more likely
they are to benefit from the results.
The Intersectoral Solution
The most effective resolution to a complex issue is a multifaceted solution. The issue of food
insecurity and food environment involves many different people, different levels of government, various
companies and is spread across many different areas of the country. Research points to the need for an
intersectoral solution that involves many different organizations and people to create effective positive
change.
One of the most salient arguments in the Sallis and Glanz report was that a multifaceted solution
is required to sufficiently solve the rise of obesity. Attacking the issue at an individual behavior level is
not effective enough to create long-lasting change in communities. As programs have tried to change
individuals eating and activity habits, the obesity epidemic has continued to increase. The report argues
that “The rapidity of the rise of the obesity epidemic and the discovery that most interventions to help
individuals change their eating and physical activity behaviors have only weak and short-lived effects
reveal the limitations of the dominant individually focused models of behavior.” Physical activity and
food environments are controlled by a wide range of public and private interests involving government
agencies at all levels, multiple major industries, professional organizations, and nonprofits. Those sectors
of society that directly relate are agriculture, food manufacturing and sales, transportation, education, real
estate, architecture, communication media, and advertising. All these groups are stakeholders, along with
the public health, medicine,and healthcare industries, that need to be engaged in efforts to create less
obesogenic environments (Sallis). Local governments must make it easy for grocery stores to come to the
needy communities. Educational programs must come alongside those grocery stores and encourage the
communities to use them effectively. Finally, the actual community members must be involved in how the
whole process pans out. Because so many different agencies are involved in the status of food and
physical activity environments, it is important to create a solution that includes the many different groups
or departments involved.

​Conclusion
Toni Lawson has suffered for every day of the 21 years she has lived in DC’s Ward 8. To her, the
answer is simple. She is training to become a community organizer to fight for increased incentives for
food retailers to move into her community, and other neighborhoods suffering from food insecurity.
Lawson knows that community action is the only way she will find power to stand against the
overpowering food industry and government. Grocery stores and local governments are responsible for
providing healthy, varied, and quality food for every community, and there must be reform to assure food
justice. Food has always been a tactic used by dominant governments to target and suppress minority
communities. Throughout early American history, access to food was a sign of wealth and elitism, and
continued to put underserved citizens in a cycle of poverty and hunger. Throughout the 20th century, food
segregated populations from interacting with one another, and still has the ability to define communities.
As junk food chains are monopolizing control and generations and developing dangerous habits, food
justice must be addressed fully. Without direct action reforming the practices of governments, food
retailers, and neighborhoods, communities will lose control of their health. Food is essential to sustaining
communities, and must be treated with the importance that it has on each American individual.
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