A question of access

Caitlin Yoshiko Kandil | 11/16/2011, 8:08 a.m.
Healthy food is in short supply in communities of color Caitlin Yoshiko Kandil...

The same Whole Foods in Fenway also boasts a range of high-quality foods like fresh organic and local produce, wild-caught fish, artisanal cheese and fresh deli meats. While considerably more expensive than other stores, the food on display at Whole Foods looks healthy and delicious.

By contrast, much of the healthy food selection at the Stop and Shop in Grove Hall looks unappetizing. Shriveled red potatoes, dirty lemons and bruised oranges pocked with decay are prominently on display in the produce section, raw salmon and catfish fillets are gray-colored, and several fried and frozen chicken breasts have noticeable freezer burn. To be fair, not all of the fresh food is unappetizing — the greens look lovely — but enough poor quality food on display surely makes healthy eating an unappealing option.

Local focus groups conducted by a private firm revealed that in the six Boston neighborhoods with the highest rates of chronic disease and obesity — Jamaica Plain, East Boston, Roxbury, North Dorchester, South Dorchester and Mattapan — residents with cars are commuting to grocery stores outside their neighborhoods to find higher-quality food at lower prices.

These discrepancies in store location and quality demonstrate that not all grocery stores are equal — also suggesting that not all grocery stores will be the solution to the access problem.

Scientific research also offers mixed conclusions on the health effects of the accessibility gap. One cross-sectional study cited in a PolicyLink report shows the direct relationship between grocery store access and a healthy diet, particularly for African Americans. For each additional grocery store per census tract, fulfillment of the U.S. Department of Agriculture’s nutritional guidelines for fruits and vegetables increased 32 percent for blacks and 11 percent for whites.

Similarly, the American Journal of Preventive Medicine published a literature review of cross-sectional studies on this topic and found, “In general, research suggests that neighborhood residents who have better access to supermarkets and limited access to convenience stores tend to have healthier diets and lower levels of obesity.”

However, a new study released several months ago challenges these conclusions. Published in the Journal of the American Medical Association (JAMA), the longitudinal study — meaning it followed the same cohort of subjects over an extended period of time, opposed to cross-sectional studies, which examine a large population only once — concluded, “Neighborhood supermarket and grocery store availability were generally unrelated to diet quality and adherence to fruit and vegetable recommendations.” The presence of a grocery store did not lead to a better diet.

While this study ignored important factors like food prices and quality that would have a clear impact on consumers’ purchases, the results point to the complexity of the access question.

Just as a grocery store — any grocery store — is not the sole indicator of equality in a neighborhood, grocery stores alone are also not the magic bullet in remedying the nation’s poor diet. Underserved communities need more than just any grocery store in their boundaries — they need stores that are accessible, fairly priced, inviting and high quality, too. Each of these factors contributes to demand, what the JAMA study showed was missing from its subjects.

For Lomax, who now must monitor his sugar level and take pills multiple times a day, the physical discomfort of diabetes has not yet begun. But those of living far from a grocery store have. “Right now my joints are bothering me,” he said. “I think I’m doing too much walking. I’ve been walking around because I don’t drive.”

When asked how frequently he can get to the nearest grocery store, he responded, “I don’t go too much.”

Next week’s installment will address the challenges of fast food in Boston. This series was funded by the University of Southern California National Health Journalism Fellowship.