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Writer's pictureSweta Balaji

Food Insecurity and Public Health

Updated: Oct 9, 2020


A volunteer transfers food to local food banks in Ohio. [Jason Whitman/Shutterstock]

Our trips to the grocery store have radically changed due to COVID-19. We’re extra cautious of what items we touch, how close we are to the person in front of us in line, and careful to clean everything we’ve bought.


However, for low income communities in Cleveland, the mere access to food is the biggest hurdle to overcome.

The United States Department of Agriculture (USDA) defines food insecurity as a “household-level economic and social condition of limited or uncertain access to adequate food.”1 Food insecurity is often confused with hunger, the individual feeling of discomfort resulted from a lack of food intake. Hunger can be an effect of food insecurity; however, both terms are not interchangeable. Hunger is mostly an individual feeling, whereas food insecurity is a systemic problem, and in this article, we will explore systemic issues surrounding access to food.

It’s often easy to place blame on poor or homeless individuals for their own plight, and we’ve especially heard this argument when it comes to eating nutritiously. But “there’s this myth that poor folks don’t want to eat well...but at the end of the day, your priority isn’t to have a balanced diet of fruits and vegetables-it’s getting through your day," as articulated by epidemiologist Dr. Erika Trapl of Case Western Reserve University’s Prevention Research Center for Healthy Neighborhoods. Additionally, one’s diet greatly depends on what foods are available in their communities. “You can’t ask people to eat what they can’t get in their neighborhood,” furthers Dr. Trapl.

So, let’s take a look at what’s inside these neighborhoods. The first issue we’ll explore is the lack of availability of stores containing nutritious foods to purchase and its correlation to healthy food intake. Dr. Trapl’s research focuses on the behaviors and risk factors that contribute to the use of tobacco and cigar products. She finds that there appears to be a correlation between the prevalence of tobacco stores in a community and food insecurity.

Cleveland is home to a plethora of tobacco retailers; however, most tobacco companies focus their advertising in low income communities. Due to the many tobacco stores and the disproportionate advertising in low income neighborhoods, “77% of public schools in Cleveland are within 1000 feet of a tobacco retailer,” according to a recent study done by Stanford University Medical School, the University of North Carolina at Chapel Hill, and Washington University in St. Louis.2




Map of prevalence of tobacco retailers and public school locations in Cleveland. [Campaign for Tobacco-Free Kids]

“So imagine that you’re walking to school, and instead of seeing a beautiful park with trees, you’re seeing a tobacco store, and another one, and another one," describes Dr. Trapl.

We often expect individuals in low income communities to find healthy foods for themselves, but through that mindset, we fail to recognize the sheer lack of availability of healthy foods that contribute to their unhealthy habits.

Now, let’s find out some of the reasons why tobacco use is so prevalent in low income communities and how it impacts food insecurity. Firstly, there is an association between a person’s socioeconomic status and their level of education, and typically, in low income communities, residents may have lower levels of education. Therefore, it’s much easier for tobacco companies to advertise their products to communities that may not understand its health effects as opposed to selling them to a community that does.

However, that's not to say that residents of low income neighborhoods are oblivious to the negative effects of tobacco. As we’ll understand further, it’s the combined factors of the lack of education about tobacco products and their increased, disproportionate availability in low income neighborhoods that contribute to their adverse effects.

Due to the over-advertising of tobacco products in low income communities, it’s easy to find more stores selling tobacco products than there are grocery stores. It’s important to clarify that the presence of tobacco retailers and lack of grocery stores are correlated; the prevalence of one does not cause the prevalence of the other. We are simply understanding one hypothesized reason as to why there may be an association between the two.

We’ve gotten a sense of the lack of nearby stores to buy healthy foods, but let’s understand what stores and services do exist in low income neighborhoods to access food.


Corner stores are popular in low income neighborhoods because they provide the community with essentials such as hygiene products, food, and over-the-counter drugs. Despite their value to low income communities, they are often seen in a negative light. Briana McIntosh is a Food Systems and Nutrition Project Coordinator for the Prevention Research Center for Healthy Neighborhoods (PRCHN), and one aspect of her research is to “change the narrative around corner stores.”



A cornerstore on 3175 W 84th St
A cornerstore on 3175 W 84th St.

Corner stores are often characterized as places where violence and other risky behaviors take place, which minimizes the importance they have in low income communities. Most, if not all stores provide their customers with milk, bread, cereal, eggs, canned goods, and some fresh items.

McIntosh’s team at the PRCHN and other grassroots organizations in Cleveland have been working on the Healthy Food Retail Initiative for over five years. The initiative is primarily funded through the Centers for Disease Control and Prevention along with local foundation support. Over 15 corner stores throughout the City of Cleveland and East Cleveland are part of these efforts. The PRCHN is leading engagement with store owners to improve upon the quality and variety of foods and connecting customers with nutrition education and other social services.


Another food access point in low income communities are food pantries. Food pantries regularly provide food and other necessary products individuals and families that cannot afford on groceries or who are unable to travel the distance to buy them. Food pantries receive their food from food banks which store millions of pounds of food in their buildings and are often found in community centers, churches or mobile vans.

One initiative that the PRCHN is tackling in Cleveland is to promote healthier food choices at food pantries through a food ranking system in which foods, depending on how healthy they are, are labeled with either a green, yellow, or red indication.

The green symbol appears on foods that are healthy and should be bought and consumed often like fruits and vegetables. The yellow symbol appears on foods that should be bought and consumed in moderation, and the red symbol appears on foods that individuals should stay away from or choose rarely.

Despite sounding like a simple system to implement, the food ranking system, in reality, requires a lot of effort and education for pantry managers and volunteers such as how to read food labels and ingredients on a product, and how to market healthy foods to pantry clients, explained McIntosh.


COVID-19 has drastically changed the way food pantries and food banks operate. Many individuals, as a result of the pandemic, have lost their jobs or have had their salaries slashed, causing many to struggle to put food on the table. Immediately, food pantries and food banks started to notice an increase in people that needed their services.3

As the pandemic continued to worsen, most food pantries switched to serving community residents through drive-thru models in order to avoid face-to-face interactions. But as you may recall from its definition, food pantries serve, not only those who struggle to afford groceries, but also those who do not have access to consistent transportation. Switching to a drive through model has put many low income individuals at an even greater struggle to gain access to food, causing food insecurity to worsen due to the pandemic.

Drive-thru food distribution at the Greater Cleveland Food Bank. [Greater Cleveland Food Bank]

So the question remains: how will food insecurity change throughout the course of the pandemic and what can we do to improve it? Throughout the year, food insecurity will be a topic of discussion for us, and we look forward to addressing it in the future.

 

References

  1. Definitions of Food Security. (2020). United States Department of Agriculture.

  2. New Study: 77% of Public Schools in Cleveland Are Within 1,000 Feet of Tobacco Retailers; City Is Home to 36 Times More Tobacco Retailers Than McDonald's. (2020). PR Newswire.

  3. Paul Morello. The first months of the food bank response to COVID, by the numbers. (2020). Feeding America.

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