8.7.1: Nutritional Access

As covered earlier in this chapter, food insecurity is associated with long term health consequences such as obesity and a higher risk of chronic diseases. This may be because food insecurity does not only include potentially skipping meals or not getting enough to eat, it also includes being forced to opt for cheaper, less-healthy food items. Access to healthy nutrition includes both the availability of healthy foods and their cost.

In order for a person to engage in healthy behaviors, they first must have an environment that allows for those behaviors. Perhaps nowhere is this more obvious than with health-supporting nutrition. According to the USDA, a healthy dietary pattern includes fruits and vegetables, grains (particularly whole grains), low-fat and fat-free dairy products, protein foods (including meat, eggs, and plant-based protein sources), and oils. Eating patterns that include these types of foods are associated with lower rates of chronic diseases including heart disease, diabetes, and some cancers. Epidemiological evidence points to higher rates of obesity and diabetes in neighborhoods with fewer fresh produce sources and more fast-food restaurants. Children who attend schools with a plethora of fast-food chains within ½ a mile tend to eat fewer fruits and vegetables, drink more soda, and are more likely to be obese than those who attended schools without fast-food nearby. Low-income and racially minoritized communities tend to also have fewer grocery stores in their neighborhoods, and have to travel farther to purchase fresh produce (Access to Foods That Support Healthy Dietary Patterns - Healthy People 2030, n.d.). This has led to the theory of “food deserts”; geographic locations around the U.S. where healthy food options are scarce, or residents have to travel long distances to reach a grocery store. These are not limited to urban areas either - ironically, people living in rural farmlands may also have to travel long distances to obtain a variety of fresh produce and protein foods. Rural food insecurity rates are similar to the high rates in inner cities (Rural Hunger and Access to Healthy Food Overview, 2024). Additionally, “food swamps” refer to areas replete with fast-food restaurants. Some studies indicate that living in a food swamp influences obesity rates even more so than food deserts. A neighborhood can be both a “food desert” and a “food swamp” at the same time (L. D. Burke & Weill, 2023). See Fig. \(\PageIndex{1}\) below.

Figure \(\PageIndex{1}\): Access to Foods that Support Healthy Dietary Patterns Infographic from Healthy People 2030.

Food prices tend to rise with general inflation, but can also outpace inflation particularly for specific food items. According to the USDA, the Consumer Price Index for foods increased dramatically in 2022 at around 10%, above the overall average increase in prices for other goods, and the largest increase in several decades (Consumer Price Index: 2022 in Review : The Economics Daily: U.S. Bureau of Labor Statistics, n.d.). This price increase was less during the following year, yet the costs of healthier foods have long been higher than the prices of less healthy, fast-foods or highly processed foods. Furthermore, people who live in low-income communities may pay higher prices for limited fresh produce options at convenience stores than those who live in more affluent communities with more large grocery stores (Access to Foods That Support Healthy Dietary Patterns - Healthy People 2030, n.d.). Fast food options and pre-packaged foods are also convenient for people who may not have time to prepare or cook whole foods purchased from a grocery store. The time-cost of healthy food becomes increasingly important to those who work multiple jobs, have long commute times, are caregivers, and/or those who have a disability.