Bad housing, high crime and poor schools are more important than transportation or income when it comes to accessing healthy food in neighborhoods historically subjected to " redlining " — the now-illegal practice once used to refuse loans, insurance or mortgages to people in certain neighborhoods that were disproportionately inhabited by racial and ethnicity minorities.
That's the main finding of a study by Sebastian Linde , a health policy expert with the Texas A&M University School of Public Health at Texas A&M Health , and colleagues with the State University of New York at Buffalo on why some neighborhoods have better food options than others.
"This suggests that simply adding grocery stores is not the answer — solutions should be found for the entire neighborhood environment," Linde said. "Understanding the root causes could prove more helpful to city planners and policymakers than previous efforts that focused only on adding food options."
He added that the issue is important given the connection between poor diet and obesity and the increase in adult obesity nationwide. Obesity among adults in the United States jumped from 30.5% to 41.9% over the last two decades, and severe cases nearly doubled to affect about 22 million adults today.
"Being poor only makes matters worse," Linde said. " Limited funds force people to buy cheap, fattening foods, and food shortages lead to stress and cycles of overeating when food is available."
In addition, redlining, which began in 1934, has left the affected areas poor and segregated, even after the practice was declared illegal in 1968. When it comes to access to healthy food, for example, many of these communities have numerous fast-food restaurants but few — or no — grocery stores .
For their study, the team analyzed four data sources:
- General U.S. Census data on nearly 9,600 neighborhoods across 38 states.
- Maps showing historical redlining .
- A tool that compares the number of grocery stores and fast-food restaurants in an area.
- A specialized dataset to identify any hidden pathways and systems that connect past differences in credit access to modern-day health differences .
The researchers then tested how health is influenced by the following, overlapping factors:
- Built environment. Local buildings, parks and physical surroundings.
- Criminal justice. Policing, safety and legal systems.
- Education. Access to quality schools and learning opportunities.
- Housing. Home affordability, safety and stability.
- Social cohesion. Level of trust and support among community members.
- Transportation. Public transit options and ease of travel.
- Wealth and income. Community financial stability and poverty levels.
Statistical analyses revealed that historically redlined areas face greater overall neighborhood hardships, with all the neighborhoods categorized as being in decline. While some had no healthy food options, some had ample options, and others were in between.
The main drivers for food access in historically redlined communities were high crime rates and substandard housing and schools.
"Increasing food security would mean policy changes as well as collaboration across housing, city planning, public health and local groups to improve neighborhoods," Linde said. "Examples might be increasing social cohesion through community gardens."
He also noted a few limitations to the study, including that its design cannot prove cause and effect; it applies only to cities and suburbs, where redlining occurred; and it did not measure every aspect of food access, such as affordability or food quality.
Despite this, he is hopeful that using neighborhood-level data to find policy solutions will prove useful.
"Helping the people who face food shortages connect, build trust and take charge of their own community health plans could go a long way in helping to reverse some of these longstanding adverse trends," Linde said.
The study was published in the journal Obesity and was partially supported by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute on Minority Health and Health Disparities.
By Ann Kellett, Texas A&M University School of Public Health
