Food desert

A food desert is an area that has limited access to food that is plentiful, affordable, or nutritious. In contrast, an area with greater access to supermarkets and vegetable shops with fresh foods may be called a food oasis. The designation considers the type and the quality of food available to the population, in addition to the accessibility of the food through the size and the proximity of the food stores.

In 2017, the United States Department of Agriculture reported that 39.5 million people or 12.8% of the population were living in low-income and low-access areas. Of this number, 19 million people live in "food deserts", low-income census tracts that are more than one mile from a supermarket in urban or suburban areas and more than 10 miles from a supermarket in rural areas.

Food deserts tend to be inhabited by low-income residents with inadequate access to transportation, which makes them less attractive markets for large supermarket chains. These areas lack suppliers of fresh foods, such as meats, fruits, and vegetables. Instead, available foods are likely to be processed and high in sugar and fats, which are known contributors to obesity in the United States.

A related concept is the phenomenon of a food swamp, a recently coined term by researchers who defined it as a disproportionate number of fast food restaurants and advertising to a supermarket. The single supermarket in a low-income area does not, according to researchers Rose and colleagues, necessitate availability nor does it decrease obesity rates and health risks.

History
By 1973, the term "desert" was ascribed to suburban areas lacking amenities important for community development. A report by Cummins and Macintyre states that a resident of public housing in western Scotland supposedly coined the more specific phrase "food desert" in the early 1990s. The phrase was first officially used in a 1995 document from a policy working group on the Low Income Project Team of the UK's Nutrition Task Force.

Food deserts in America and the UK have been most widely studied due to the Western origins of the concept. Initial research was narrowed to the impact of retail migration from the urban center. More recent studies explored the impact of food deserts in other geographic areas (such as rural and frontier) and among specific populations like minorities and the elderly. The studies addressed the relationships between the quality (access and availability) of retail food environments, the price of food, and obesity. Environmental factors can also contribute to people's eating behaviors. Research conducted with variations in methods draws a more complete perspective of "multilevel influences of the retail food environment on eating behaviors (and risk of obesity)."

Advocates within the Food Justice movement have identified that terms like "Food Desert" undermines how the intersections of race and class largely influences minority communities' inaccessibility to fresh foods. To better describe what is taking place, activists such as Karen Washington have begun to use the term "food apartheid." The activist and community organizer Karen Washington describes the term as "[looking] at the whole food system, along with race, geography, faith, and economics." As a result, there has been a paradigm shift within the movement with community organizers encouraging members of affected neighborhoods to consider how inadequate food systems correlate with the intersectionality of race and class. The Planting Seeds Just Tour serves as an example, as it visited solution based projects to resist injustices with ecological wisdom and food justice that were run by women of color. The tour also highlighted economically viable alternatives to provide healthy food and created spaces in which community members could participate in conversations regarding sustainability.

Definitions
Researchers employ a variety of methods to assess food deserts including directories and census data, focus groups, food store assessments, food use inventories, geographic information system (GIS), interviews, questionnaires and surveys measuring consumers' food access perceptions. Differences in the definition of a food desert vary according to the following:
 * The type of area, urban or rural
 * Economic barriers and affordability of accessing nutritious foods, including the cost of transportation, price of foods, and incomes of those in the area
 * The distance to the nearest supermarket or grocery store
 * number of supermarkets in the given area
 * type of foods offered, whether it be fresh or prepared
 * nutritional values of the foods offered

The multitude of definitions, varying by country, has fueled controversy over the existence of food deserts.

It should also be noted that because it is too costly to survey the types of foods and prices offered in every store, researchers use the availability of supermarkets and large grocery stores (including discount and supercenter stores) as a proxy for the availability of affordable nutritious food.

Types
The term "urban food deserts" is traditionally applied to North America and Europe, but in recent years, the term has been extended to Africa as well. It has taken time for researchers to understand Africa's urban food deserts because the conventional understanding of the term must be reevaluated to fit Africa's unconventional supermarkets. There are three categories for food deserts: ability-related, assets-related, and attitude-related. Ability-related food deserts are "anything that physically prevents access to food which a consumer otherwise has the financial resources to purchase and the mental desire to buy." An asset-related food desert involves the absence of financial assets, which prevents consumption of desirable food that is otherwise available. Attitude-related food deserts are any state of mind that prevents consumers from accessing that foods they can otherwise physically bring into their home and have the necessary assets to procure. In Cape Town, South Africa, supermarkets take up a large portion of retail space. While supermarkets are expanding in poor neighborhoods in Cape Town, their food insecurity is growing at an alarming rate. That is one of the biggest roadblocks in understanding food deserts. Based on the European or American understanding of food deserts, the fact that there is access to supermarkets by definition would mean that Cape Town does not suffer from food deserts. Africa suffers from food deserts, and there is also a direct link between climate change and the rapid growth of food deserts. While supermarkets are expanding to areas in which they once did not exist, there is still a disparity when it comes to physical access. In Cape Town, asset-related urban food deserts are the main reason for food insecurity since its people cannot afford the food that they would prefer to eat.

Climate change can play role in urban food deserts because it directly affects accessibility. The main way that climate change affects food security and food deserts is by reducing the production of food. With the limited availability of a product, the price rises making it unavailable to those that cannot afford more expensive commodities. In Cape Town specifically, supermarkets rely directly on fresh produce from the nearby farm area. Climate change affect the production of food, and it can also damage capital assets that affect accessibility and utilization. Specifically in Cape Town, access to food deserts does not change their severity. With limited diversity in their diets, those who live in Cape Town are highly dependent on foods of low nutritional value and high calorific value. Using the European or American definition of food deserts would not take into account the dynamic market of other cultures and countries.

Causes of food deserts
Food deserts have primarily been studied in Western countries due to limitations around applying the retail access definition to different communities with varying cultures, food sourcing strategies, and environments around the world.

A USDA study published in 2009 observed that low access to supermarkets in the U.S. are affected by various characteristics of neighborhoods and the geography of a community. The study cited income gaps, segregation by race, socioeconomic status, transport availability and infrastructure, rurality, segregation by income, and percentages of vacant homes in a community as variable factors that determined the degree of communities' access to supermarkets. Within the United States, academic scholars have proposed several different causes behind the formation of food deserts. One proposed theory behind the emergence of food deserts (defined as areas with low supermarket access) is the expansion of large chain supermarkets that displaced smaller food stores from neighborhoods. Scholars cite the greater appeal of large chain supermarkets to individuals because of the wider variety and better values of food they offer as well as longer business hours compared to smaller, independently or family-owned grocery stores, leading to decreased demand and support for smaller food stores. The expansion of large chain supermarkets and loss of smaller food stores can create certain areas where only individuals with transportation can access, creating areas of disproportionate retail access that some scholars characterize as a food desert.

Another proposed theory behind the formation of food deserts in the US is the shift in inner-city demographics in the 1970s-1980s. During this time period, many higher-income households moved from urban to suburban areas, lowering the median income in inner-city areas and causing supermarkets to close in these regions as a result. In three of the biggest inner-city areas in the U.S, over half of the supermarkets were reported to have closed due to this shift in demographics.

Supermarket redlining has also been proposed as a cause of lower access to supermarkets that is characteristic of some scholarly definitions of food deserts. The concept describes how large chain supermarkets tend to relocate out of or refrain from opening stores in inner-city areas or impoverished neighborhoods due to perceived urban and economic obstacles, decreasing certain communities' access to supermarkets. Businesses' perceived urban obstacles include decreased demand compared to suburban neighborhoods; higher land, wage, and utility costs; and increased crime in urban areas. Economic factors such as supply and demand that businesses take into consideration are affected by a complex web of interconnected factors (e.g. demand for fresh produce is affected by people's socioeconomic status and cultural upbringing).

In addition, as several studies have shown the discrepancies in the number of supermarkets in predominately black neighborhoods compared to predominately white neighborhoods, the characteristics of a neighborhood population are suggested to be motivations behind some business' reluctance to open in certain neighborhoods. The decreased availability of supermarkets in certain communities increases the distance people have to travel to get food, further limiting food access for people without access to reliable transportation.

Crime can serve as both a cause and effect of the development of food deserts in urban areas; theft in stores can lead to increased prices for food, which can lead to more theft in a vicious cycle. This correlation between crime and food deserts is also heavily dependent on race; while violent or property crime are not statistically associated with food deserts in general, they are increasingly associated with it when the neighborhood has a higher Black population. This effect may result from white flight or from more limited access to transportation in the Black community.

Food deserts have been created by shoplifting and looting in neighborhoods in the U.S. cities of Chicago,     Minneapolis,   Philadelphia,  Pittsburgh, San Francisco,      and Seattle.

Transportation and geography
People tend to make food choices based on what is available in their neighborhood. Food deserts often have a high density of fast-food restaurants and corner stores that offer prepared and processed foods.

According to the United States Department of Agriculture (USDA), community food security "concerns the underlying social, economic, and institutional factors within a community that affect the quantity and quality of available food and its affordability or price relative to the sufficiency of financial resources available to acquire it." Rural areas tend have higher food insecurity than urban areas because food choices in rural areas are often restricted, with transportation being needed to access a major supermarket or a food supply that offers a wide, healthy variety of foods. Smaller convenience stores typically do not offer as much produce.

It is critical to look at car ownership in relation to the distance and number of stores in the area. Distance from shops influences the quality of food eaten. A vehicle or access to public transportation is often needed to go to a grocery store. When neither a car nor public transportation is available, diets are rarely healthy because fast food and convenience stores are easier to access and do not cost as much money or time. Further, those who walk to food shops typically have poorer diets, which has been attributed to having to carry shopping bags home.

Natural Disasters and Food Deserts
Food access can be restricted in an area that is hit by natural disasters. Access to stores in low-income neighborhoods can be blocked when roads are flooded. Building damage can delay store openings. After Hurricane Harvey, grocery stores were not able to resume normal operation as they faced issues of infrastructure damage and supply issues. This situation was particularly dire for low-income communities, as they often have fewer resources to cope with such disasters and are more likely to live in areas prone to flooding and lacking in food retail options. This resulted in supermarkets in low-income neighborhoods being closed longer than other stores, which only worsened pre-existing inequalities. There were less supermarkets available after Hurricane Katrina hit New Orleans. Access to supermarkets in predominately Black neighborhoods was already limited prior to the storm. The Storm increased racial-disparities in food access and access to supermarkets.

Beyond physical access
The primary criterion for a food desert is its proximity to a healthy food market. When such a market is in reach for its residents, a food desert ceases to exist, but that does not mean that residents will now choose to eat healthily. A longitudinal study of food deserts in JAMA Internal Medicine shows that supermarket availability is generally unrelated to fruit and vegetable recommendations and overall diet quality.

In a 2018 article in Guernica, Karen Washington states that factors beyond physical access suggest the community should reexamine the word food desert itself. She believes "food apartheid" more accurately captures the circumstances surrounding access to affordable nutritious foods: "When we say food apartheid the real conversation can begin."

Access to food options is not the only barrier to healthier diets and improved health outcomes. Wrigley et al. collected data before and after a food desert intervention to explore factors affecting supermarket choice and perceptions regarding healthy diet in Leeds, United Kingdom. Pretests were administered prior to a new store opening and post-tests were delivered two years after the new store had opened. The results showed that nearly half of the food desert residents began shopping at the newly built store, but only modest improvements in diet were recorded.

A similar pilot study conducted by Cummins et al. focused on a community that was funded by the Pennsylvania Fresh Food Financing Initiative. It followed up after a grocery store was built in a food desert to assess the store's impact. The study found that "simply building new food retail stores may not be sufficient to promote behavior change related to diet." Studies like those show that living close to a store that is stocked with fruits and vegetables does not make a large impact on food choices.

A separate survey also found that supermarket and grocery store availability did not generally correlate with diet quality and fresh food intake. Pearson et al. further confirmed that physical access is not the sole determinant of fruit and vegetable consumption.

Work and family
People who have nonstandard work hours, including rotating or evening shifts, may have difficulty shopping at stores that close earlier and so opt instead to shop at fast food or convenience stores, which are generally open later. Under welfare-to-work reforms enacted in 1996, female adult recipients must log 20 hours a week of "work activity" to receive SNAP benefits. If they live in a food desert and have family responsibilities, working may also limit time to travel to obtain nutritious foods as well as prepare healthful meals and exercise.

Safety
Additional factors may include how different stores welcome different groups of people and nearness to liquor stores. Residents in a 2010 Chicago survey complained that in-store issues like poor upkeep and customer service were also impediments. Safety can also be an issue for those in high-crime areas, especially if they must walk while carrying food and maybe also with a child or children.

Behavior and social and cultural barriers
The likelihood of being food insecure in the US for Latinos is 22.4%, for African Americans 26.1%, and for whites 10.5%. People who are food insecure often find themselves having to cut back more at the end of the month, when their finances or food stamps run out. Month to month, there are other special occasions that may lead to higher spending on food such as birthdays, holidays, and unplanned events. Because people who are food insecure are still fundamentally involved in society, they are faced with the other stressors of life as well as the additional frustration or guilt that comes with not being able to feed themselves or their family.

Steven Cummins also proposed that food availability is not the problem but eating habits. Pearson et al. urge food policy to focus on the social and cultural barriers to healthy eating. For instance, New York City's public-private Healthy Bodegas Initiative has aimed to encourage bodegas to carry milk and fresh produce and residents to purchase and consume them.

Pharmacies
In addition to the close proximity of fast-food restaurants and convenience stores, many low-income communities contain a higher prevalence of pharmacies, compared to medium- or high-income communities. Such stores often contain a high number of snack foods, such as candy, sugary beverages, and salty snacks, which is within arm's reach of a cash register in 96% of pharmacies. While pharmacies are important in these communities, they act as yet another convenience store and so further expose low-income residents to non-nutritional food.

Nutrition
A key element of a food desert is its lack of healthy and nutritious foods. As food deserts are typically defined by household's decreased access to supermarkets and healthy food acquisition sources, areas defined as food deserts tend to have a greater number of fast food restaurants and convenient stores that are often more accessible and affordable for households. Convenient/corner stores and fast food restaurants frequently carry more processed foods than fresh, unprocessed foods. The widespread availability of processed foods in food deserts poses increased health risks to residents: a high dietary intake of ultra-processed foods, which contains higher contents of sodium, salts, sugars, and additives than fresh foods, has been consistently linked to higher risks of negative health and metabolic outcomes.

Limited access to nutritious foods in food deserts can greatly impact one's ability to engage in healthy practices. Food access, affordability of the food, and health literacy are all social determinants of health that are accentuated by living in a food desert.

A few studies suggest that differences in demand for healthy food also contribute to poor health in food deserts.

Impacts to community health
The concept of deprivation amplification has been proposed as an explanation of how food deserts can perpetuate poor health outcomes for a community: scholars suggest that residents of low-income neighborhoods' exposure to inadequate and unhealthy food environments can increase their individual risk factors for disease and poor health. However, a 2019 study published in The Quarterly Journal of Economics cast doubt on the notion that exposing poor neighborhoods to healthy groceries reduces nutritional inequality. The study found "that exposing low-income households to the same products and prices available to high-income households reduces nutritional inequality by only about 10 percent, while the remaining 90 percent is driven by differences in demand".

In addition, past literature has suggested that lower retail access to supermarkets is linked to select cardiovascular health outcomes, and some studies have shown that increased access to supermarkets lowers individuals' risk of obesity with opposite outcomes for convenience stores. However, many scholars have highlighted the limitations of these studies due to their localization, short time frame, focus on a singular health outcome (people's health are assessed through multiple measures of health, not just one factor), and inability to account for all the social determinants of individuals' health outcomes.

Scholars have asserted that while these studies can give insight into how food accessibility can contribute to health outcomes, because of the intersecting social determinants of health that contribute to individual health outcomes, the results cannot be interpreted as a casual relationship between food deserts and poor health outcomes.

Food deserts are just one aspect of people's individual food environments: food environments consist of the intersecting spheres of community food options (supermarkets, small stores, etc.); work/school/home food options (school food, home purchases); and individual food intake, all of which determine an individual's health outcome. Likewise, individual characteristics (demographics, socioeconomic status, etc), physical environment (retail access, transportation, etc), and households' social environments (cultural/social norms, etc) all impact diet, which is a determinant of health outcomes and a factor in certain diseases. Furthermore, an individual's food environment is one of many social determinants of health that contribute to his/her health outcomes: social determinants of health such as transportation infrastructure, urban planning, the built environment, and local policies also contribute to a person's health outcome. Due to the complex intersecting factors of social determinants of health, studies have suggested that a community and individual's socioeconomic status (resource and economic deprivation) are more associated with negative health outcomes, rather than a lack of food access that is characteristic of food deserts.

Another study found that grocery stores are more closely spaced in poor neighborhoods and that there was no relation between children's food consumption, their weight, and the type of food available near their homes.

Another study suggested that adding a grocery store near one's home was associated with an average BMI decrease of 0.115, which very small compared to the excess BMI of an obese person.

Alternative frameworks to food deserts
Several studies have pointed out potential limitations of applying the concept of food deserts to addressing issues of food disparity and unhealthy food consumption, particularly in non-Western countries.

As food deserts is a concept that originated in the U.K. and is primarily studied in Anglo-Saxon countries, several scholars have questioned the applicability of food deserts to countries in the Global South. Scholars point out that food deserts are typically defined as a lack of access to supermarkets (spatial focus) and that its framework operates with the assumption that increased supermarkets means increased availability of healthy foods. Some urban researchers argue that this current framework for identifying food deserts fails to consider additional spatial and non-spatial factors that contribute to household's food access and incorrectly assumes an increase in the number of retail food options will directly mitigate issues of food access and food insecurity within all local food systems. While the traditional framework assumes homogeneity between people's experiences in their local food system, scholars cite additional factors such as travel time, crime, food acquisition outside an individual's home neighborhood, employment, income, and other household-specific behaviors that influence people's access to food. In addition, several studies have highlighted alternative food sources that deem supermarket access less relevant in transitioning countries such as many in Africa and rainforest cities in Brazil. For example, recent studies highlight that alternative food acquisition sources such as food vendors, small shops, open-air markets, urban agriculture, and food transfer between households are more frequently visited than retail food options in Africa's various cities. Likewise, a 2017 study conducted in Brazil highlights the critical role of non-retail sources such as fishing, farming, and home gardens in people's food security and access. Due to the overlapping, context-specific factors unique to different local food economies that influence household food access and food security, some scholars emphasize the need to adjust the definition and framework of food deserts to specific contexts in order to effectively and holistically address food insecurity, nutrition disparities, and food access issues in developing countries.

Several researchers have also proposed shortcomings in the current definition and framework of food deserts in the U.S. when working to lessen unhealthy food consumption, diet disparities between different communities, and food insecurity. Some researchers criticize the primary focus of current food desert frameworks - lack of retail access - as a one-dimensional over-simplification of food security and access issues that fails to address structural issues to reduce unhealthy food consumption and diet disparities. Likewise, some scholars argue that the current definition frames food access as a binary problem (either you are in a food desert or not), which overstates the problem of space when food access is a complex, multi-dimensional problem involving other critical factors such as transportation infrastructure, income, time, and consumer behavior. Several researchers have also cited longitudinal studies that do not observe a connection between food access and health outcomes and highlight data that suggests increased retail access does not necessarily improve the dietary choices and subsequent health outcomes of a community.

Alternatively, scholars propose a model that addresses the complex intersection of individual behavior and food choice with social and political forces to solve issues of hunger, food security, and food access.