Access to healthy foods worse in poor areas

NEW YORK (Reuters Health) - People who live in poorer neighborhoods in the U.S. are less likely to have easy access to supermarkets carrying a wide variety of fresh produce and other healthy food, an analysis of 54 studies confirms.

But they probably have plenty of unhealthy fast food joints to choose from, Dr. Nicole I. Larson of the University of Minnesota in Minneapolis and her colleagues found.

"The research I reviewed suggests there is a need for new policies and other local actions to address the problem of poor access to healthy foods in many lower income, rural, and minority communities," Larson told Reuters Health.

Evidence is mounting, Larson and her team note, that segregation of neighborhoods by "income, race, and ethnicity" plays a major role in US health disparities, and accessibility to healthy -- and unhealthy -- food may be a factor.

To investigate, they reviewed studies published between 1985 and 2008 that looked at food access by neighborhood in the United States. While supermarkets are likely to sell the widest variety of healthy foods at the cheapest prices, convenience stores usually charge more, and tend not to sell fresh food, the researchers note in the American Journal of Preventive Medicine.

The studies they reviewed confirmed that minority and low-income individuals who live near supermarkets have healthier diets. For example, one investigation found that the likelihood that African-Americans would meet guidelines for fruit and vegetable consumption rose by 32% with every additional supermarket located in the census tract where they lived.

Three studies found a reduced risk of obesity among people with more supermarkets in their neighborhood; two of these studies found a link between better access to convenience stores and increased obesity risk.

Research also clearly shows "stark racial and ethnic disparities" in the type of food stores available in neighborhoods, according to the researchers. One study showed that mostly-black neighborhoods had half as many chain supermarkets as predominantly white neighborhoods, while Hispanic neighborhoods had a third as many such stores as white areas.

Six studies in which investigators actually visited stores and checked out the merchandise found healthy foods like fresh produce, low fat dairy foods, high fiber breads and lean meats were more available and of higher quality in white neighborhoods than non-white neighborhoods. Rural communities also tend to have worse access to supermarkets, the researchers add.

Possible ways to encourage supermarkets to set up shop in lower income neighborhoods could include "financial incentives, helping to conduct market feasibility studies, assistance with parking/transportation plans, and assistance with site cleanup/assembly," Larson said. However, she added, there has been very little research on evaluating strategies or policies for reducing inequalities to access to healthy foods."

But the experience of other countries shows that there's no reason it can't be done; Larson pointed out that studies in New Zealand, Australia, Canada and Scotland found that supermarket availability was actually greater in lower-income neighborhoods.

SOURCE: American Journal of Preventive Medicine, January 2009.