Why we can’t ignore food in health

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Today in Slate, Heather Tirado Gilligan argues that food deserts are not really a problem. She also argues, using data from three studies, that introducing healthful food to low-income  communities makes no difference to health outcomes. I don’t entirely disagree. Parachuting a bunch of bananas into a low-income grocery store isn’t going to change the way people eat, or have a real impact on health outcomes. Making fresh, healthy food more physically accessible is just the first step. She overlooks the other steps involved in de-food-desertification; ensuring that the food is affordable, providing nutrition education and (as she touches on and thereafter ignores) teaching people with little time and little money how to cook quick, cheap and healthy meals. As Pearson et al argue, policies need to be developed to change cultural attitudes to food, rather than just food accessibility (1).

The way Gilligan writes about it seems as though she expects to just stick a few bulbs of fennel in a community that’s previously only had access to Doritos and Taco Bell and hope that it makes a difference. Of course it doesn’t! Fixing nutrition is a much more complex issue than I think Gilligan is acknowledging and it’s going to take a lot of time. For example, she notes that ‘Since 2004 there’s been a sharp spike in the number of programs like Soul Food that are aimed at reducing such health disparities by making fresh food more accessible to low-income people’ and that ‘Study after study has shown that the fresh-food push does nothing to improve the health of poor people, who continue to live markedly shorter and sicker lives than better-off Americans.’ It’s hard to argue against that – poorer people definitely do still have poorer health outcomes. But the data that she’s referring to is for only ten years in a nation of 314 million people, where the number of programs and locations where they have been available have been limited. It’s long enough to start getting some idea of outcomes, but I would argue, not long enough for concrete conclusions, especially when the aims of these programs are overwhelmingly long-term – it’s not possible to change a lifetime of eating habits overnight. Finally, I would also argue that if you look at what’s happened since 2010 when the Health Food Financing Initiative was introduced, it will give a much clearer idea of the impact of an increased number of programs. The same data problem persists though –  that at this stage, there are only three years of data to work with. It’s really too early to make the call that the Initiative is failing, especially when new and innovative programs are being developed every day.

Anecdotal evidence suggests that just as some food programs are not working so well, others are making a difference in the lives of those who have access to them. And while it’s hard to dispute Gilligan’s claim that the stress of poverty has a likely significant affect on health outcomes, it seems far too soon and very short sighted to disregard the importance of providing the means to improve the diets of low-income communities when aiming to reduce the burden of disease.

(1) Pearson T, Russell J, Campbell M J, Barker M E 2005, Do ‘food deserts’ influence fruit and vegetable consumption?—a cross-sectional study, Appetite 45(2): 195-197.

 

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