Diabetes Forecast

Bringing Healthy Fare to Big-City "Food Deserts"

Can better food help stop the spread of diabetes?

By Andrew Curry , ,

Researcher: Joel Gittelsohn, PhD, MS
Occupation:Medical Anthropologist, Johns Hopkins University Bloomberg School of Public Health
Focus: Nutritional Intervention
Research Funding: Clinical/Translational Research Award

It's called the "grocery gap": Studies in urban areas from Los Angeles to Chicago to Philadelphia and Baltimore have shown that people living in inner-city neighborhoods simply don't have access to the foods they need to eat healthfully.

The problem is that large grocery chains usually don't put stores in poor neighborhoods, and poor people often don't own cars, which makes shopping more than a few blocks from home next to impossible. "The supermarkets that do exist are far away, and people have to take a taxi or bus to get there," says Joel Gittelsohn, PhD, MS, a medical anthropologist at Johns Hopkins University. "Transport is a major issue."

Researchers call these underserved areas "food deserts," vast swaths of urban America where healthy food simply can't be bought. The holes left behind as big chains relocated to suburbs over the past 40 years have been filled by small corner stores, convenience stores, and drugstores, which are unlikely to stock much in the way of fresh fruits and vegetables, low-fat milk, or whole wheat bread. And small stores tend to charge more than big grocery chains. Faced with a lack of affordable, healthy choices, people living in poor urban areas turn to cheap meals from fast-food chains or high-fat, high-sugar processed foods from corner stores. The impact is measurable, particularly when it comes to diabetes. In one study of Chicago neighborhoods, there were more than twice as many deaths from diabetes in areas with the worst access to grocery stores as in neighborhoods with good access.

Gittelsohn has been working on community-based programs to fight diabetes for nearly 20 years, from Native American reservations to the nation's cities. With help from the American Diabetes Association, he's set up an intervention trial in Baltimore to measure the impact of food deserts on diabetes risk. "What we're doing is working with local churches to increase the availability of healthy food choices around those churches," Gittelsohn says. "It's about access, about making sure people have access to healthy food choices."

His latest project builds on a long-running ADA initiative called Project Power, a series of faith-based educational workshops for African Americans. He divided participating Baltimore churches into three groups: One group will take part in the Project Power program while Gittelsohn works with neighborhood stores to increase the availability of healthy foods and with local YMCAs and recreation centers to increase opportunities to engage in physical activity. The second group will conduct Project Power workshops, but without any "environmental intervention" in the neighborhood. The third group gets nothing, for now; they'll be the control group, helping Gittelsohn measure whether the other programs make a difference. (When the trial is over, the control-group churches will also take part in Project Power.)

As part of an earlier study in Baltimore, Gittelsohn worked with small stores to increase their supply of more healthful foods. One issue, they learned, was a fundamental disconnect between store owners and local customers. "When you speak to community members, they say they'd love to eat healthy, but it's not available, it's of poor quality, or it's too expensive," says Gittelsohn. "Store owners say, 'We'd love to stock this stuff, but nobody buys it.' "

Add to that the difficulty and cost of stocking fresh produce on a small scale—mom-and-pop stores can't negotiate bulk discounts the way a giant chain like Safeway can, for example—and you have a powerful disincentive for inner-city store owners to shake up what they stock. Gittelsohn's intervention helps them overcome that barrier. The team uses small incentives to encourage grocers to take the first step: They'll subsidize the first 10 gallons of low-fat milk a store buys, for example, to demonstrate that there is demand for it. Other elements include in-store advertising materials to highlight healthy food choices and information for churches identifying local stores participating in the program.

With the help of Project Power, Gittelsohn works the other side of the fence, too. Researchers are working with church leaders to revamp the menus served at church socials, taking a look at the food churches provide to members in need, and encouraging congregations to support farmer's markets on church property. Says Gittelsohn: "It's not something as simple as saying if we affect the food environment around the church, we'll affect church members." In the long run, figuring out how to get more
large grocery chains to invest in inner cities may be the best solution to the deadly "grocery gap." But in the meantime, Gittelsohn is trying to work with store owners and shoppers alike to bring some greens to America's food deserts.

To sponsor an ADA research project at the Research Foundation's Pinnacle Society level of $50,000 or more, call Elly Brtva, MPH, managing director of Individual Giving, at (703) 253-4377,
or e-mail her at ebrtva@diabetes.org.



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