After a Decade of Food Access Work, Are People Eating Any Healthier? | Civil Eats

After a Decade of Food Access Work, Are People Eating Any Healthier?

From “food deserts” to “food apartheid,” four experts whose work spans the nation survey the past 10 years of the food access landscape.

person shopping in a grocery store

The interconnected issues of equity and food justice may finally be gaining ground in the national dialogue, but whether or not Americans have access to fresh and healthy food still has everything to do with their zip codes. Communities across the nation are grappling with food insecurity in both urban and rural settings, and many government programs designed to help those in need, including immigrants, are currently under threat.  Meanwhile, questions of nomenclature—whether low-access food communities should be called “food deserts” or better described as suffering from “food apartheid”—have shed light on the structural and systemic issues at play.

To mark Civil Eats’ 10th anniversary, we’re conducting a series of roundtable discussions throughout the year in an effort to take an in-depth look at many of the most important topics we’ve covered since 2009. In the conversation below, we invited four experts to discuss their own work on food access, as well as trends in the field and potential solutions.

David Procter is the director of the Kansas State Rural Grocery Initiative; Samina Raja is a professor of urban and regional planning who focuses on food access and food systems planning at University at Buffalo’s School of Architecture and Planning; Ashanté M. Reese is an assistant professor of sociology and anthropology working on food and race and food inequities at Spelman College; and Sarah Reinhardt is the lead food systems and health analyst at the Union of Concerned Scientists’ Food & Environment program. Civil Eats’ editor-in-chief Naomi Starkman and managing editor Matthew Wheeland facilitated the wide-ranging discussion. The conversation has been edited for clarity and length.

How has food access changed over the last decade? What were some of the bigger issues a decade ago, and what are they now? And how might our approaches to addressing the problem need to change?

Ashanté Reese

Ashanté Reese

Ashanté Reese: One of the biggest changes I’ve noticed is that the definition has become more nuanced since the early 2000s. At around that time, food access was almost synonymous with supermarkets or grocery stores, and I think now people are really asking: What are other ways for us to imagine and create more access that isn’t just about adding another corporation into a neighborhood?

Samina Raja: In 2008, I did a study in Buffalo titled “Beyond Food Deserts,” but somehow people still think that I suggested that “food desert” was a good frame—it’s not. That study was an attempt to draw the attention of local governments to recognize that there are racial and income disparities in neighborhoods. In my work over the last decade, we’ve gone from convincing local governments that food systems are something we ought to think about, to raising the issue of food access. It’s definitely not a marginal conversation any longer.

Even so, some local governments have actually developed what my colleagues and I call “food blinders:” They’re unable to connect food to broader social issues.

Reese: I don’t think that we can stress the blinders enough. We really have to be able to see food as [connected to] other social issues. And I have found that to be incredibly hard, both methodologically as a researcher, and also in working with activist groups that [don’t yet know] how to think about issues intersectionally.

David Procter

David Procter

David Procter: My work revolves around the rural sector, and I would say that number one, access to healthy food has become more on the radar of food retailers in rural parts of the country—they now see it as an important piece of their grocery operations.

Another significant change in rural places is the distribution patterns of wholesale foods. There’s been more and more consolidation, and so it’s becoming increasingly difficult for retailers in small towns to be able to purchase food from their wholesalers. In fact, probably all across the country, there’s been shrinkage in terms of the number of stores that are open, so healthy food is typically less available.

I have also noticed that, increasingly, stores are being owned in some communal way: More and more people are looking at co-ops or non-profits, or they’re looking at some sort of combination of government and private entrepreneurship in terms of owning a grocery operation.

Sarah Reinhardt: The term “food desert” has become very popular and very deeply embedded in the public health vernacular over the last decade. In one sense, we’ve grown leaps and bounds in our ability to start measuring different aspects of our food environment. But we also need to be looking at a much bigger picture, and “food desert” really isn’t doing us justice—it’s ignoring a lot of the larger structural features of our food system.

I want to credit [urban gardener] Karen Washington for her use of the phrase “food apartheid,” because I think it takes this concept of a food desert and it acknowledges that these areas don’t just happen by accident. They are the result of intentional policy decisions that have accumulated over years and years and have continually reinforced [the idea] that certain populations should have access to healthy food and others don’t matter.

For the most part, we’re now recognizing that our agricultural policies are making it harder to ensure that we all have access to healthy food. For example, only 2 percent of U.S. crop land is used to grow fruits and vegetables and about 60 percent is used to grow commodity crops like corn and soybeans, which are primarily used to produce meat, processed food, and ethanol.

This has two really troubling implications for food access. The first is that we’re not actually producing the kinds of food that we need; if everybody were to meet dietary recommendations for fruits and vegetables, we’d need to nearly double the production of those crops. The second implication is that many of the big industrial farms producing corn, soy, and wheat aren’t taking good care of the soil, and that will jeopardize our ability to grow food there in the future. If we want to help the food supply now and for years to come, healthy soil and a healthy environment also have to be key ingredients.

What other terms—other than “food deserts” —do you think better describe or reflect communities’ lack of access to healthy food?

Reese: I also have started using “food apartheid” more. If I’m talking to a general crowd—rather than to my university students, with whom I have more time to go into these issues—I do talk about racial segregation in conjunction as a prerequisite for creating low food access. And I always explain why I don’t use the term food desert and why I hope it dies a rapid death soon.

People who don’t have access to healthy food—that doesn’t happen overnight. The way we have labeled the problem has dictated the solutions, and those that have been rewarded have all been these big, neoliberal solutions that more deeply entrench us into capitalism, which is part of why we have this problem in the first place. So I also use “low food access.”

samina raja

Samina Raja

Samina Raja: I also wish that the term would disappear.

I work at a very local, neighborhood level, and different people will describe their neighborhood very differently. If they’re describing the problem, they may say, “We don’t have supermarkets here.” That’s a fairly good, precise definition. But others might say, “There are some great things about our neighborhood—we have community gardens here.” People don’t have a difficult time describing their neighborhoods, but when [policymakers and planners] try to come up with quantitative measures that allow us to compare many places, we run into [misleading] terms.”

We have one neighborhood in Buffalo that by federal guidelines is described as a food desert, but it had a thriving mom-and-pop grocery store in it. So if you went to look for grant funding, it would bring in a competitive supermarket that wouldn’t hire local people. So defining a neighborhood as a food desert would thwart an existing, functioning grocery store because it didn’t fit the idea of a supermarket. I’m much more in favor of letting residents decide how they want to define their neighborhood and getting to the precision of the issue whether it’s a problem or an asset.

Procter: I guess the phrase that we use most often here is “low access to healthy foods.” We are primarily talking to operators, entrepreneurs, business people, about their rural food operations, and so we probably would not use terms like food apartheid—it sets up barriers for us. We do talk about the percentages of produce grocers are selling; we talk with them about selling fruits and vegetables from local growers or farmers’ markets or anywhere else they can get local foods.

Sarah Reinhardt

Sarah Reinhardt

Reinhardt: I love the idea of asking communities to define the food access issues they’re facing in their own words. I also think the public health community is beginning to recognize that food access, no matter how you define it, can’t fully explain and will never really fully solve the extreme and persistent health disparities that we still see among various populations. It’s part of the bigger picture, and if the public health field wants to make progress in addressing diet-related chronic diseases and the disproportionate impact they’re having on low-income populations and communities of color, we have to take a good look at the root causes, including wealth inequality, educational inequality, and persistent, systemic racism. These factors shape our ability to live healthy lives. At some point, the conversation has to also get beyond just, “Can you access healthy food or not?”

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Reese: Public health as a field has also changed a lot in being willing to address root causes. Not everyone in public health does that, and I want to note that what Sarah said is on the progressive side of public health. But rooting the problem in something other than individual bodies, particularly in people of color’s bodies, is something that I think public health has grown toward—not just behavioral change but also thinking about structures.

Raja: I’d add one more point. The fundamental problem is that among scholars and policymakers who focus on Black and brown communities, there isn’t discussion about control over the food system: Who actually owns the means of production? Who owns the business? Who controls the wages in grocery stores? We can describe the physical absence of retail stores in the best possible way, but that’s still a partial analysis of the structural problem that we face. My concern is not just that the term [food desert] doesn’t fully capture what is in the food retail environment, but that it doesn’t tackle the question of agency at all.

Reinhardt: On the flip side, it also absolves us of the responsibility to be accountable for the policies that created so-called food deserts in the first place. If, 40 years ago, we hadn’t run a highway through this community, we wouldn’t have a food desert today. [The term] makes it sound like it’s a natural phenomenon that’s outside human control. It absolves us of the responsibility to acknowledge that it was by design.

Have we run the risk of placing too much emphasis on the power of grocery stores to change people’s diets?

Reese: In my research in Washington, D.C., without question, people say they want a supermarket. We do need to be able to give people what they need. Overwhelmingly, people in the U.S. rely on supermarkets, so why wouldn’t people who don’t have access to them immediately want access to a store?

When we see how much supermarkets have grown in square footage between 1960 and the present, there is a deeper question to me around American values, at the center of which [is] convenience. Convenience is degrading our planet, and has become so valued that it’s hard for most of us to even think about eating in season when we can go to a supermarket and have pretty much whatever we want year-round. But one part of the food access question is how do we as a nation, as a globalized world, radically rethink our relationship to convenience? And I don’t have an answer to that.

Urban farmers market photo by Mael Balland on Unsplash

Photo by Mael Balland on Unsplash.

Procter: Supermarkets are critical—they’re one of the anchor institutions in small [rural] towns, and if they go away, it’s a serious blow to literally the sustainability of that town. Our research has found that they’re important for some really big reasons: They’re the best place in town to get healthy food. There’s more variety and there’s a greater quantity than any other place in town. And with the exception of a Dollar General or other dollar stores—that’s another change in the last 10 years, all these dollar stores that are moving in—supermarkets are cheaper than any other place in town. So they’re important for nutrition reasons.

They’re also important for economic development reasons; they support other businesses and they’re connected to other businesses—and that’s absolutely true in in small towns. They’re a barometer for how the town’s going to go economically. If the grocery store struggles, research shows that the other businesses in town are going to struggle as well.

Plus, again in small towns, they’re hiring plumbers and contractors and electricians, and all of those folks are most likely locally sourced. They’re one of the primary employers in a small town. And finally, they are a social hub, where people meet people and a vibrant social gathering place in these towns.

This issue of convenience is also a challenge for people and grocery stores in small communities; if you live in a small town but work in a larger metropolitan area, people seek the convenience of buying all their groceries in the city when they leave town from work. But we’re trying to encourage folks to think long-term about the viability of these small towns, and without a grocery store that becomes really difficult.

Reinhardt: There’s certainly a real and immediate need for a place where people can get healthy food, and a grocery store plays multiple functions in any given area. And for folks who are redeeming food stamps or using the WIC program, it’s really important to have a place that offers a variety of food and accepts these benefits.

But we need to be thinking more broadly about the root causes of hunger and food insecurity. Do they go away when you put a new grocery store in your town? And, if not, then what else needs to happen?

Raja: For me, grocery stores and supermarkets are important not necessarily just for the food access question but for the broader contribution to a place. In the Buffalo-Niagara metropolitan area, we have about 2,000 food retailers. About 3 percent of those are large supermarkets and less than 20 percent are smaller markets. Irrespective of what they do for the food system, they are significant sources of employment—about 12,000 people in the area.

I’m not sure that we should expect grocery stores and supermarkets to be the lever for changing people’s food behavior. They play many other roles, like David said. My colleague’s research, who does work on obesity, has shown [in a trial with youth enrolled in a clinical program to reduce obesity] that the relationship between behavior and what’s available in a grocery store doesn’t go in the direction that we expect it to go. Yes, grocery stores offer a lot of fresh fruits and vegetables, but they also contain a lot of unhealthy choices. So the science on the pathways between behavior and what’s available in stores is not that clear.

There are lots of innovative models of grocery stores… with cooperative grocery stores as an example. I think there’s a lot of room for innovation. But I don’t necessarily see [grocery stores] as the place to start when we talk about diet and behavior.

Reese: In my book [Black Food Geographies], I look at a small grocer in a neighborhood designated as a low food access area. That store meant so much to people, for so many reasons that weren’t about food: It had been continuously owned and operated by the same family since 1948, which is a huge deal in D.C., where there’s such intense gentrification. All the reasons people really value this store came out in people’s interviews without me ever asking about it. In our focus on supermarkets, we still overlook and obscure those smaller grocers, the international markets, and the ethnic markets.

There was news recently about how participation in the Women Infants and Children (WIC) programs is way down over last year partly due to anti-immigrant policies from the White House as well a systemic barriers that make it harder for people to participate. And are there any clear solutions that might reverse this downward slide?

Procter: The challenge that we have in rural areas with food assistance programs is the stigma that’s attached to being enrolled in the program. We have noticed that most of the rural counties of Kansas are really under-enrolled in terms of the numbers of people who would be eligible. When folks live in these small towns where everybody knows their business, [that stigma can prevent enrollment because] many times grocery cashiers know who is on food assistance. We’ve done some training with owners and grocery employees about their interactions with customers, including those that are on food assistance.

Over the past couple years, we have been part of a FINI (Food Insecurity Nutrition Incentive) grant to try to expand the Double Up Food Bucks program into rural areas of Kansas. We’ve had some success with that in terms of people recognizing that that’s an opportunity and signing up for SNAP.

Reese: In Atlanta, there has been a lot of work by grassroots and community-oriented groups to figure out ways to honor and partner with people who have WIC or other forms of assistance so they can use them in farmers’ markets and other community places.

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There is one small grocery store, Carver Market here in south Atlanta, with an attached coffee shop called Community Grounds. They work really hard to keep produce affordable but also to destigmatize any forms of public assistance and to accept as much as possible. It’s been really interesting to see their work. The coffee shop is interesting because it creates a space to sit and hang out in a neighborhood that doesn’t have many public spaces.

People working in the vegetable garden with a green house

Raja: I don’t have data on the trends on WIC and other kinds of public assistance in Buffalo, but I do have some examples of where the community has stepped up in the absence of public support.

It is a refugee resettlement city, and the city of about 260,000 people has 14,000 to 15,000 refugees from several countries. There is some work happening with refugee communities centered on giving them the means of production and control rather than just increasing their access to food. We have a Somali Bantu community organization that has started its own farm. We also have an economic development initiative, so that the city actually has refugee-led businesses.

But I agree that it’s a huge challenge. For refugees in particular, there are barriers thrown up by differences in language, access to public services, transportation, non-inclusionary behavior in grocery stores—there are a lot of challenges that they report, so getting enrolled in WIC and SNAP was already hard, and sadly I’m not seeing anything on the horizon that would bring us back to where we were a couple of years ago.

In refugee resettlement cities in the U.S., there is a real opportunity for food organizations to help make these services more visible to resettlement agencies. Because right now […] there’s nothing in place to ensure that they sign up for WIC and SNAP, and that’s a really important gap.

Reinhardt: It’s worth saying that, although we haven’t seen substantial drops in SNAP participation on a national level yet, there is a constant and very real threat of cuts to that program. This administration clearly believes that folks who are using food assistance are just not working hard enough. That doesn’t bear out in the data, but it hasn’t stopped this onslaught of attacks on the federal safety net.

There are people in organizations building political power around food justice that really didn’t have the means to do it a decade ago. The HEAL Food Alliance is a national coalition that formed in 2015 with a goal of transforming our food and farming systems; that group now has about 50 member organizations representing everybody from rural and urban farmers, fishers, farm and food chain workers, scientists, public health advocates, environmentalists, indigenous groups, and more. Their platform for real food includes 10 different guiding principles and is really one of the best examples out there of a holistic policy platform aimed squarely at food justice and making sure we support people to access healthy food, and to make sure that we keep pursuing a better future for all of us.

What do you wish the average member of the public understood about food access, and is there anything out there that gives you hope for the next 10 years?

Raja: My hope would be that people recognize that when local governments take simple actions, like making a decision about their sewer line or road system or land use plan, they’re actually making a food decision. We think of roads and sewers and park systems as public infrastructure, and we expect our local governments to deliver that—but somehow we don’t see the very fundamental need for food as coming from a public infrastructure.

Procter: I hope people would come to recognize that in rural communities, there is real power in small groups of people. My hope is also that they stop believing it’s somebody else’s responsibility, because everyone’s going to have to pull together. My hope is also that these innovative models of rural food retail continue to take root and that these communal operations, in whatever form they might take, continue to flourish in small towns.

Reinhardt: I wish the general public understood that if we don’t take drastic and immediate action to try to shift that the food system we’re currently operating in, the challenges that we face in healthy food access will be multiplied tenfold in the coming years.

The national conversation we’re having about climate change, sparked by reports like the national climate assessment and policies like the Green New Deal, is starting these important conversations, and I really hope that that cultural and political moment will drive us to arrive at a shared understanding of the full implications of a sustainable food system—not just one that’s talking about protecting our water and soil and climate, but also about the viability of the farming profession and about the treatment and well-being of the people who grow and pack and sell our food. A lot of our food system right now is precariously predicated on the exploitation of a lot of people, including immigrants, it isn’t sustainable for any of us.

Reese: What I want people to know is that, while we might casually think of food as this kind of basic human need and human right, that is not how [people in power] treat it in this country. There are ways that we can push forward and think more expansively and radically about how we can create a world where food access is not something that keeps people up at night.

What brings me hope is knowing how many people are working in a tradition of folks named and unnamed, on issues related to food access. When I am talking to my students, I see hope in the fact that they are carrying out what we get to teach them in probably more radical ways than I can imagine. I would also like to uplift HEAL and the National Black Food and Justice Alliance as networks that give me hope; this is their life’s work to think about how we create a world where this is not an issue. And being in alignment with them keeps me grounded and hopeful.

Top photo by Anggit Rizkianto on Unsplash.

Since 2009, the Civil Eats editorial team has published award-winning and groundbreaking news and commentary about the American food system, and worked to make complicated, underreported stories—on climate change, the environment, social justice, animal welfare, policy, health, nutrition, and the farm bill— more accessible to a mainstream audience. Read more >

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  1. Ben Volk
    Thank you for posting this article. It was very informative as well as validating to hear from many in this space that food access (food insecurity or food justice) is a multifaceted issue. I just completed my master’s degrees and my thesis focused on the question “how can organizations improve poor diets in low income communities.” Although food assistance programming is crucial, I believe we need to find ways that bypass the need for reliance on food assistance and government while also considering the core issues. Part of the issue is that the core issues vary with community and the are many ways to tackle the issue of healthy diets and food access.
  2. Thank you for this piece, it was a great read. I am currently working on a redevelopment project in Baton Rouge and I am trying to develop innovative concepts to alleviate food desert/swamps in the area. I wanted to do a farmer's market initially but after reading the article I think a portfolio of options are perhaps the approach to take. Do you have any recommendations for innovative options? Also do you have any sources of funding to design and implement such projects.

    Thank you for your time.


  3. Such a great article! A very important topic that more of us should be discussing and taking part in fixing as well.

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