A "food desert"in a rural community is defined as no market within 10 miles. The USDA defines it as no ready access to nutritious foods within 1 mile. The USDA estimates that 17.1 million people, 1/8 Americans and 13 million children live in food deserts. And with these staggering numbers, lack of nutritious food options is probably underreported because corner markets that sell packaged foods, candy and slushies count as a "grocery store".
What is filling in for the lack of grocery stores that offer variety, fresh fruits and vegetables and nutritious options for poor people? Dollar Stores. Dollar Stores are the fastest growing food retailers in the United States. The Dollar Store chain opened more than 2000 stores between 2019 and 2021 and plans on 1050 new ones in 2023. The majority of these are targeted for low-income, mostly POC communities.
We are in the midst of a nutritional crisis in the United States of America. Obesity, diabetes, cancer, heart disease, Alzheimers are all associated with poor nutrition. And it is not a surprise that the health of poor people, and people in rural communities is worse. When there are no options for grocery shopping than the corner Dollar Store, there is no way a family can eat a healthy diet. Foods and beverages stocked at Dollar Stores are lower in nutrients and higher in calories. A study published this month from Tufts University in The American Journal of Public Health reported a nutritional divide with households headed by people of color, lower income and in rural areas more dependent on food from Dollar Stores.
We scratch our head as the cost of health care continues to rise. We can put our money into pharmaceuticals, hospitals, organ transplants, diabetes drugs and funeral homes or we can start with preventive medicine. The reason advanced "Socialized" countries have better health outcomes than the US is because they put their resources into public health and prevention. The access to nutritious and affordable food is prevention and it needs to start in childhood.
So what could we do? We could incentivize grocery stores and supermarkets in underserved communities through tax credits. Municipal programs funded by the government can support small neighborhood stores and farmers markets. Co-ops could be a focus but they need start up capital and ongoing operational support. Municipalities could fund community gardens and provide capital for true grocery stores to enter a community. The Institute for Local Self-Reliance (ILSR) says, "Solving the broader problem will require action from State and Federal Policymakers, including checking the predatory tactics of Dollar chains and reforming the financial system which delivers vast pools of capital to the chains, while denying loans to local grocers to expand in low income communities".
These are the social determinants of health. Until we start paying attention, we will not have a healthy nation.