Over the past several years researchers have made progress in assessing the role that the food environment plays in eating patterns. Previous work has shown a positive correlation between consumption of fruits and vegetables and the location of grocery stores (17
). Others have found a positive association between what people eat and the selection of healthy options in the supermarket (20
). We have also increased our understanding of the neighborhood factors that influence or are associated with differences in the food environment. Researchers have found better access to supermarkets in wealthier communities than in poorer communities and in white neighborhoods than in African American neighborhoods (17
). More recent work indicates, however, that it may not be the location of the food outlets but the selection of food in the outlets that is associated with the ability to meet recommendations on dietary intake (30
The primary purpose of this study was to determine whether there were differences in the extent to which populations have access to the infrastructures — fast food restaurants and supermarkets — necessary to adopt the eating behaviors recommended by the USDA to reduce chronic disease and promote health. Our work expanded the inquiry into access to foods that meet dietary recommendations and neighborhood characteristics. Similar to findings in other studies (18
), our results showed that there were differences among neighborhoods in the location of food outlets. Our results also showed differences in the availability of healthy food options. Moreover, our data suggest that the differences are at least partially explained by differences in racial distribution and poverty rates. These two factors (race and income) seem to be associated not only with the location of food outlets but also with the selection of food available that enables individuals to follow dietary recommendations (as seen in the analysis of the supermarkets and fast food restaurants in the highest tertile). The data suggest that individuals living in mixed or white high-poverty areas and in primarily African American areas (regardless of income) are less likely to have access to food outlets than individuals in primarily white, higher-income communities. Also, the food available in mixed or white high-poverty areas and in primarily African American areas is less likely to enable individuals to make healthy choices than food available in primarily white, higher-income communities.
This study has several limitations. First, our study is limited to an urban midwestern region, and the findings may be different in other areas nationally and internationally. Second, our study is limited to an area that has a primarily African American and white population. The relationships of interest may be different when making comparisons among racial and ethnic minority communities and between these communities and white communities. In addition, people may not necessarily eat where they live. Like other researchers, we examined the number of food outlets within a census tract (18
) rather than the distance from a neighborhood center to the food outlet (19
). We made a similar assumption: although it is possible that individuals and groups leave their geographic area to find healthy food options, many individuals, particularly those in lower-income communities, do not have access to cars or public transportation to allow this type of movement regularly. Lack of transportation was likely among residents living in our study area; according to the 2000 census, almost 50% of residents (48.8%) do not have a vehicle available (25
). Thus, the location of food outlets within a census tract seems to be a reasonable indicator of access when conducting an area-level analysis. Another limitation to our work is that it is possible that the location of food outlets is a function of other geographic factors, such as proximity to a highway, mall, or airport. It might be useful for future studies to examine the potential influence of these other geographic factors and land-use patterns on food access.
Lastly, there is a compelling and rational economic argument that supermarkets and restaurants do not sell items that will not be purchased. Therefore, our findings (differential access to recommended food options) may be the result of behavior rather than the cause of behavior. It is impossible from a cross-sectional study such as ours to determine causality. The purpose of our study was to determine whether there were differences in the extent to which populations have access to the infrastructures necessary to adopt the eating behaviors recommended by the USDA to reduce chronic disease and promote health. Although we found differences according to racial composition and poverty level, our work does not indicate why these differences exist. Moreover, our work does not incorporate many of the other factors that influence dietary habits or purchasing (e.g., individual knowledge and skills, household size and composition, cultural factors). Future studies, both qualitative and quantitative, would assist in furthering our understanding of these issues.
Regardless of the reasons, some communities have less access than others to the food necessary for meeting recommended eating behaviors. Without a change in access to these foods, individuals cannot change their eating behaviors. If indeed these eating patterns are required to reduce chronic disease and promote health, then these communities will continue to have disparities in critical health outcomes unless we work to change current conditions. We in public health must begin to work collaboratively with our business communities and political structures to make it reasonable, rational, and economically sound to provide equal access to healthy choices.