Giving the Poor Easy Access to Healthy Food Doesn’t Mean They’ll Buy It

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In 2010, the Morrisania section of the Bronx was what is commonly called a food desert: The low-income neighborhood in New York’s least-healthy county had no nearby grocery store, and few places where its residents could easily buy fresh food.

That’s why it was the target of a city tax incentive program designed to bring healthy food into underserved neighborhoods. In 2011, a 17,000-square-foot supermarket opened, aided by city money that paid some 40 percent of the costs of its construction. The neighborhood welcomed the addition, and perceived access to healthy food improved. But the diets of the neighborhood’s residents did not.

This verdict comes from a study that compared shopping behavior in Morrisania with a neighborhood a mile away with similar demographic characteristics. “There were not a lot of things that really changed,” said Brian Elbel, an author and an associate professor of medicine at New York University. “Consumption didn’t really change. Purchasing didn’t really change.”

The work adds to a growing body of evidence that merely fixing food deserts will not do nearly as much to improve the health of poor neighborhoods as policy makers had hoped. It seems intuitive that a lack of nearby healthy food can contribute to a poor diet. But merely adding a grocery store to a poor neighborhood, it appears, doesn’t make a very big difference. The cost of food — and people’s habits of shopping and eating — appear to be much more powerful than just convenience.

Another study, published this week as a working paper by the National Bureau of Economic Research, looked across the country and found that no more than a tenth of the variation in the food people bought could be explained by the availability of a nearby grocery store. The education level of the shoppers, for example, was far more predictive. “If you were going to put all Americans in the same retail environment, you’d end up only dealing with 10 percent of this disparity between college-educated and high-school-educated households,” said Jessie Handbury, an assistant professor at the Wharton School of the University of Pennsylvania, and an author of the paper.

Tackling the problem of food deserts has been embraced by the federal government and many local governments. The federal government’sHealthy Food Financing Initiative has handed out more than $500 million in recent years to help encourage grocery stores to locate in places they had avoided. Many states and cities — like New York — have their own programs, aimed at getting more grocery stores and farmer’s markets into poor neighborhoods where the consumption of fresh fruits and vegetables is low and obesity rates tend to be high.

Still, all that investment may not pay off in the form of healthier communities. The recent paper looked at the buying habits of families who agreed to allow all of their bar-coded food purchases to be scanned and measured, along with details about their address and demographic characteristics. That data allowed the researchers to track what people bought according to their incomes and education levels, as well as their neighborhoods.

The research, like the work that initially described the food desert concept, noted that lower-income neighborhoods tended to have less healthy food nearby and that their residents tended to eat less healthy diets. The researchers set out to see whether those disparities could be explained by access issues, or by more entrenched preferences for particular kinds of foods.

It turned out that food preferences dominated. When the researchers looked at shoppers with lower levels of income and education living in richer neighborhoods with more accessible healthy food, their shopping mimicked that of low-income, less educated people in poorer neighborhoods. (And the reverse was true, too: Richer, more educated shoppers in poor neighborhoods looked more like rich shoppers in rich neighborhoods.)

“When we put supermarkets in poor neighborhoods, people are buying the same food,” said Barry Popkin, a professor of Nutrition at the University of North Carolina, who participated in an Institute of Medicine review of food desert research in 2009. “They just get it cheaper.”

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