“Socioeconomic status is the most powerful predictor of disease, disorder, injury and mortality we have," says Tom Boyce, chief of UCSF’s Division of Developmental Medicine. His statement couldn't be more true.
To this day, many Americans still struggle to feed their families healthy foods. For some, food deserts- limited supermarket areas- hinder their ability to access healthier options. Food deserts are disproportionately found in areas of low income and or areas with people of color. According to a 2009 study from the National Research Council on the Public Health Effects of Food Deserts, people who live in areas with poor access to healthy food are 55 percent less likely to have a good-quality diet. For families who need to travel several miles by bus to grocery shop, they are also inevitably at a higher risk of exposure to the COVID-19 virus.
What about families who do not live in areas with food deserts? Surely, they have access to a supermarket and should be able to buy nutritious foods, right? Many professionals believe this, so it is no surprise that affluent Americans would too. Contrary to this belief, however, food prices still pose a significant barrier to low-income families. Where single mothers or working parents juggle long hours, it makes sense that food preparation can not be top on their priorities. Instead, they look for more convenient methods, that still fill hungry bellies, and are not prone to spoilage.
If we want to look at why low-income families, specifically, eat so poorly, we have to examine how they spend their grocery money. In a study conducted on 202 urban households in the city of Chicago, Illinois, food purchase receipts of each household were analyzed for 14 days. These food purchase receipts were then scored according to Nutrition Data System for Research (NDS-R) and the 2010 Health Eating Index (HEI). The results? Lower-income households had significantly lower HEI values compared to higher-income households. Closer examination of this total HEI value reveals that, indeed, lower-income individuals consume fewer fruits and vegetables, less dairy, and more high- sugar drinks and frozen foods. The energy one can obtain from healthy foods is three times more expensive than unhealthy foods.
Moreover, the fast-food industry- one of America's most lucrative industries- offers fast, cheap, convenient, and filling food: all combined an appealing alternative when you're in a pinch on the money. Areas of concentrated poverty have higher fast-food access compared to less impoverished CBGs: money creates these health disparities. What's even more interesting is that, according to the Los Angeles Times, "socioeconomic status affected not just access to healthy food [for low-income families], but something even more fundamental: the meaning of food." While the study found that 96% of high-income families denied their children's requests for junk foods regularly, only 13% did in low-income families. Why? Because junk-food is a pleasure that they can afford. For parents who have to repeatedly say no to other requests, this ability to afford something as simple as junk-food can bring a sense of competence.
Finally, why are the poor associated with being unhealthy? Well, it's because they are not only disadvantageous in affording healthier options but also in affording healthcare. For instance, in 2010, prediabetes was prevalent among one in 11 children. Today, this number has risen to 1 in 4. “If you look at minority populations, 50 percent of African Americans and a third of Latino children will develop diabetes in their lifetime" says Kirsten Bibbins-Domingo, director of CVP.
So how do we combat this? Building supermarkets in food deserts won't. Doctors can try to help. The expansion of Medicaid would be a start. But, ultimately, without addressing poverty head-on, there will never be anything better than a band-aid to coverup wounds. As the Ferguson Commission reports, the average life expectancy in the mostly black Missouri suburb of Kinloch is more than three decades less than in the mostly white suburb of Wildwood. This is the reality. A conversation originating at food access quickly becomes one about the disadvantageous low-income families or minorities, and then one of, health risk, and finally life expectancy. We need a healthcare system that fights for the marginalized and the impoverished- one that focuses on the cause of diseases, poverty, not the diseases themselves.
Sources:
1. Junk food's meaning to low-income families: https://www.latimes.com/opinion/op-ed/la-oe-singh-food-deserts-nutritional-disparities-20180207-story.html
2. Minority and low-Income families' access to junk-food: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783380/
3. Poverty is the disease: https://www.ucsf.edu/news/2016/01/401251/poor-health-when-poverty-becomes-disease
4. Can low-income families even afford a healthier diet: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847733/#:~:text=Lower%2Dincome%20households%20purchase%20more,bananas%2C%20and%20frozen%20orange%20juice.
5. Chicago HEI Study: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6546-2
6. Americans still lack healthy foods: https://recipes.howstuffworks.com/americans-still-lack-access-to-healthy-food.htm
7. Gap price between healthy foods and unhealthy foods: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4190277/
8. Pandemic worsens food deserts:
9. Energy from unhealthy foods is 3x cheaper than healthy foods: