Neighborhoods Left Behind

Food deserts are a complex phenomenon that require multi-pronged action By Birju Rao

Food has become an increasingly popular way to enjoy what the diverse cultures of Chicago have to offer. The availability of low-fat alternative foods has grown exponentially over the past decade. Even for vegetarians like myself, plenty of healthy options abound. But not everyone has access to these foods.

When I first heard the term “food desert” in an undergraduate class, it was just another bit of jargon to be memorized and regurgitated on an exam. As I parsed through my class notes, I found the definition I had scribbled: “no nutritious food, lots of fast food—bad combination.” This didn’t help me much, so I consulted experts in the field. They gave me some devastating figures about life expectancy, cost, and distances to fresh food sources in Chicago:

• Individuals living in food deserts have a cardiovascular disease death rate of 11% and a diabetes death rate of 1.27% compared to respective rates of 5.7% and .56% in non-food deserts.
• African-Americans make up more than 54% of the food desert residents—most of them are single mothers and children.
• Individuals who live in an African-American majority neighborhood have to travel on average .77 miles to a chain grocer and .81 miles to an independent grocer—dispelling the myth that smaller or independent grocers are more likely than chain grocers to locate in African-American communities.

The phenomenon of food deserts was uncovered in response to Centers for Disease Control and Prevention and census report data that showed a strong relationship between an individual’s cardiovascular health outcomes and zip code. These data anomalies were discounted for years. Even today many still believe that residents in these neighborhoods simply lack the will to eat healthier food. In the clinic, we often forget that this is a food problem and end up labeling people non-compliant.

The biggest food deserts in Chicago are centralized on the West and South Sides. Walking through these neighborhoods I counted almost a dozen McDonalds, 7-11s, and liquor stores, but I didn’t see one grocery store. When I asked people on the street if they knew where the closest grocery store was, they either said that they didn’t know or pointed out a convenience store. Before visiting some of these neighborhoods, the phenomenon of food deserts seemed to fly in the face of everything I had learned in economics. Fresh food grocery stores should be lining up to open in these areas because they could tap into a sizable market without facing any competition. But after walking through the neighborhoods, I learned that gangs, drugs, and shootings have all conspired to make certain neighborhoods far too risky for entrepreneurs to open a grocery store. When we add the violence-related deaths in these neighborhoods (506 in 2012) to the deaths related to poor nutrition, we arrive at a very large body count.

Clinicians stymied

The morbidity of these food deserts stymies the work of clinicians. It’s ineffective to recommend that the patient improve her diet when she lacks access to fresh fruits and vegetables. Food deserts also place an extensive financial burden on hospital systems and can cause decreases in funding due to what lawmakers see as “non-compliance.”

The most obvious solution in the face of any market failure is government intervention. Using subsidies or tax breaks, city officials could help incentivize the establishment of more grocery stores that carry fresh produce. However, it's not too hard to foresee that these could escalate, creating a significant financial burden on the City. In fact, according to the Center for Rural Affairs, one in five grocery stores has gone out of business in the last four years in rural areas. Perhaps government intervention could be a short-term fix, but over the long-term, it’s not economically viable.

Some communities across the nation are tackling the problem creatively. After a survey in a Minneapolis food desert revealed that 94% of residents would purchase more fresh produce if it were available at convenience stores, city officials enacted the Minneapolis Health Corner Store Initiative, requiring all corner and convenience stores to stock a certain amount of fresh fruit on their shelves. An initiative from Indiana University, called Garden on the Go, uses food trucks to deliver fresh produce at an affordable price and even accepts food stamps.

Food deserts are incredibly complex because they are linked to the very problems that humanity has struggled with throughout its history—crime, decay, and violence. Though many proposed solutions are not perfect, they are steps in the right direction. George Kaplan, a Thomas Francis Collegiate Professor of Public Health at the University of Michigan, eloquently remarked on the etymology of the word desert. He comments: “A desert is, of course, a place distinguished by the absence of vegetation, rain, etc.... But the word “desert” is also a verb–“to leave someone without help or in a difficult situation and not come back.” This seems to me to capture an important dimension of food deserts not conveyed by the noun.”

Birju Rao is a medical student at the University of Illinois at Chicago.