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Social Equity, Health and Healthy Food Access

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Grant E. Rissler
April 30, 2019

Improved health outcomes are a broad policy and social equity concern. Access to fresh, healthy and less processed foods is a key factor in health outcomes. Reducing areas without access to such foods, often called food deserts, represents a key equity opportunity for policymakers. Four core dimensions of social equity provide a rubric for understanding how access to healthy food can play a role in enhancing or reducing health equity.  

A 2017 Washington Post article highlighted positive racial equity news on life expectancy in the United States: From 1999 to 2015 the mortality gap between black and white Americans shrunk by half. But it also pointed to key continuing disparities—life expectancy at birth for black Americans is still 3.5 years less than for white Americans.

Health outcomes are complex, but maintaining a healthy diet that minimizes processed foods is a frequent recommendation for improving them. Following the recommendation is harder for those living in food deserts without easy access to grocery stores and affordable fresh produce. Closing the racial gap in life expectancy requires attention to these challenges.

As with a prior column, our discussion uses a rubric of four core dimensions of social equity articulated by Susan Gooden and summarized in the visual below: equity of access; procedural equity, equity in quality of services and equity in outcomes.

I must also note that my own awareness of equity in healthy food access benefited from participation in VCU’s Minority Political Leadership Institute (MPLI) and being part of a team researching the racial equity impact of Virginia 2018 House Bill 69, which proposed the creation of a grocery store investment fund in Virginia to increase healthy food access in current food deserts.  

Equity of outcomes.                                                                                           

Differences in mortality outcomes between black and white Americans were mentioned above. The sources and resources listed below point towards additional disparate outcomes and useful resources:

Equity of access

The outcomes mentioned above are affected by access to healthier types of food. Location and income are two key factors in determining whether an individual or a community can eat healthily. The concept of food deserts draws together both of these access factors. A 2009 US Department of Agriculture report estimated that 23.5 million Americans lived in a food desert (a low-income census tract more than a mile from a grocery store). Those most at risk would be low income individuals (11.5 million of the 23.5 listed above) and those from the 2.3 million households had no access to a vehicle and were outside the same 1 mile range of stores.

As policymakers aim to eliminate food deserts, the importance of focusing on the nexus of low-income and low-access populations (compared to only thinking about low access) is illustrated by the following graphical analysis of Virginia localities (originally compiled for the MPLI project mentioned above). The boxcharts below (interactive versions are available here) show numbers of people facing low access (top chart) and low access/low income (bottom) based on data from the USDA Food Desert Atlas. Based on racial demographics from the United States Census, localities are shaded blue to indicate a lower white share of the population than the state average of 68.7 percent, and green a higher white share).  

As this shows, including a low-income factor shifts our first focus away from the relatively affluent Washington, D.C. suburb of Fairfax (200,000 low access residents but only 19,000 that are both low income and low access) and toward several more minority-rich localities (darker blue) such as Norfolk, Hampton and Richmond City. As we’ll see in the next section, the difference in focus matters for policy construction.

Procedural equity

Here in Virginia, one proposed tool for shrinking food deserts was the 2018 House Bill 69, which sought to establish a Virginia Grocery Investment Program and Fund. Though not passed, the bill is a good example of procedural pitfalls. As written, the bill defined the focus for proposed investments as low access areas, rather than a more focused target of low income/low access areas. As noted in our group’s MPLI racial equity analysis of the bill, the difference in definition could result in outcomes that worsen racial disparities rather than improve them.  

Equity in quality of services

Increasing the number of grocery stores is not the end of the story, as not all grocery stores offer the same quality of healthy food options for the same price. A 2018 article by Gosliner et. al found that shoppers at stores in low-income areas faced a 27% price mark up in large grocery stores. Attention to what happens inside grocery stores is also an important factor.

Conclusion

This discussion is not comprehensive, but moving intentionally through the four core social equity dimensions related to healthy food access teases out a range of important factors. Among the most important is the need to keep a focus on the intersection of geographic access and low-income populations.  


Author: Grant Rissler is a full-time parent and an affiliate faculty member in the L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University (VCU). He edits the Governance Matters section of State and Local Government Review and is the current secretary of the ASPA Section on Democracy and Social Justice (SDSJ). His broad research focus is social equity and peacebuilding with particular interest in local government responsiveness to immigrants. Grant can be reached at [email protected].

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