Exploring Food Access and Health Disparities Sarah Buila, Southern Illinois University, Illinois, USA Abstract: I joined the wellness committee at the counseling center where I worked. We talked about how to increase our health habits and those of our co-workers. We organized lunch hour walking parties, got group discounts at a health club and decided to have a potluck luncheon in order to share our healthy recipes and sample the food. My co-workers talked about recipes that are low in fat, low insaltandsugarless.Often thismeantartificialsweetenersandfatsubstituteswerepartof theirrecipes. No one said anything about avoiding processed foods or eating less meat. No one said anything about eating more fresh fruits and vegetables, whole grains or organic and locally grown foods. It was at this very moment that I realized I was from a different planet. The planet I come from calls for a much different diet. The planet that I’m from has poor and affluent people alike who are obese. While in some parts of the world people are starving. Race, class, and gender influence health outcomes. What we eat is influenced by outside factors and I see people getting further away from the source of all food, theearth.Food isonecommondenominator inhealthdisparities.Onmyplanet therearedispar- ities in access to healthy foods. Part of the solution is related to broadening awareness. Coming up with solutions means coming up with new definitions about what is healthy food, and redefining our roles as health care practitioners/world citizens. Could it be that there is a diet that is not only good for you, but good for your global neighbors and the earth? Keywords: Diet, Health Disparities, Food Access, Global Health THIS PAPER EXPLORES the relationship between health outcome disparities andaccess to food prefaced on the principle that diet is one of the most important factorsimpacting health. It is not recent news that there are health disparities according to racial/ethnic, gender, and socio-economic status. Much of the literature which ad- dresses the problem of health disparities is focused on proving they exist. Identifying causes for these disparities is a much more complicated endeavor. If we are going to close the gaps between health disparities it is a worthwhile endeavor. Contributing to the difficulty in identifying causes is the multifaceted nature of human health and the individual and varying contexts which support (or don’t support) health and wellbeing. These facets include heredity, access to health care and disease prevention, lifestyle, stress, and diet. The focus of this article is on food and health conditions resulting from dietary choices and food availability. Health Disparities Health disparities exist for many different vulnerable populations. Worldwide, poverty is a significant indicator of health disparities. People who are poor experience a higher prevalence of chronic disease, higher mortality rates, stress, and lower life expectancy .

1. Exploring Food Access and Health Disparities
Sarah Buila, Southern Illinois University, Illinois, USA
Abstract: I joined the wellness committee at the counseling
center where I worked. We talked about
how to increase our health habits and those of our co-workers.
We organized lunch hour walking
parties, got group discounts at a health club and decided to have
a potluck luncheon in order to share
our healthy recipes and sample the food. My co-workers talked
about recipes that are low in fat, low
insaltandsugarless.Often
thismeantartificialsweetenersandfatsubstituteswerepartof
theirrecipes.
No one said anything about avoiding processed foods or eating
less meat. No one said anything about
eating more fresh fruits and vegetables, whole grains or organic
and locally grown foods. It was at
this very moment that I realized I was from a different planet.
The planet I come from calls for a much
different diet. The planet that I’m from has poor and affluent
people alike who are obese. While in
some parts of the world people are starving. Race, class, and
gender influence health outcomes. What
we eat is influenced by outside factors and I see people getting
further away from the source of all
food, theearth.Food isonecommondenominator
inhealthdisparities.Onmyplanet therearedispar-
ities in access to healthy foods. Part of the solution is related to
broadening awareness. Coming up
with solutions means coming up with new definitions about
what is healthy food, and redefining our

2. roles as health care practitioners/world citizens. Could it be that
there is a diet that is not only good
for you, but good for your global neighbors and the earth?
Keywords: Diet, Health Disparities, Food Access, Global Health
THIS PAPER EXPLORES the relationship between health
outcome disparities andaccess to food prefaced on the principle
that diet is one of the most important factorsimpacting health. It
is not recent news that there are health disparities according to
racial/ethnic, gender, and socio-economic status. Much of the
literature which ad-
dresses the problem of health disparities is focused on proving
they exist. Identifying causes
for these disparities is a much more complicated endeavor. If
we are going to close the gaps
between health disparities it is a worthwhile endeavor.
Contributing to the difficulty in
identifying causes is the multifaceted nature of human health
and the individual and varying
contexts which support (or don’t support) health and wellbeing.
These facets include
heredity, access to health care and disease prevention, lifestyle,
stress, and diet. The focus
of this article is on food and health conditions resulting from
dietary choices and food
availability.
Health Disparities
Health disparities exist for many different vulnerable
populations. Worldwide, poverty is a
significant indicator of health disparities. People who are poor
experience a higher prevalence
of chronic disease, higher mortality rates, stress, and lower life
expectancy (Mackenbach,

3. Stirbu, Roskam et al. 2008; Chambers, Narayan, Shah, &
Petesch, 2000). There are health
disparities amongst indigenous peoples globally (Gracey &
King, 2009) and racial and ethnic
The International Journal of Health, Wellness and Society
Volume 1, Issue 3, 2011, http://HealthandSocietyJournal.com/,
ISSN 2156-8960
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groups within the United States. For example, the United States
Department of Health and
Human Services (2003) has documented higher rates than
whites, of cardiovascular disease,
diabetes, some forms of cancer and kidney disease in African
Americans, Hispanic Latinos,
Native Americans, Alaska Natives, Native Hawaiians, and
Pacific Islanders. Despite the fact
that women live longer all over the world, women experience
health outcome disparities in
some parts of the world. The risks associated with child birth
equalize life expectancy rates
in poorer and less developed nations. Women are also more
vulnerable to HIV infection in
Sub-Saharan Africa, North Africa and the Middle East (United
Nations, 2010).
The Healthy Diet Connection to Health
It is generally accepted that a healthy diet is part of what makes
us healthy. Food consumption,
for many is something that can be altered in order to improve
health. Cardiovascular diseases

4. are the leading cause of death worldwide. The World Health
Organization (2004) states that
80 percent of deaths from heart attack and strokes could be
prevented with healthy eating,
avoiding tobacco, and exercising. Consumption of fruits and
vegetables can help to prevent
cardiovascular diseases and some types of cancer, diabetes,
obesity and micronutrient defi-
ciencies (World Health Organization, 2003). Related to food
consumption, there is a
worldwide obesity epidemic with the number of overweight
persons reaching over one billion.
The amount and types of food eaten coupled with inactivity are
the culprits. Many diseases
are attributed to obesity. These include: type two diabetes,
coronary heart disease, stroke,
hypertension, pregnancy complications and some forms of
cancer. Simultaneously, there
are approximately 1 billion people who suffer from hunger; a
diet of insufficient food
quantity and nutrient rich foods deficient (Gardner, & Halweil,
2000). Malnutrition hits
children in low-income countries the worst. It stunts their
growth, and increases childhood
mortality. Women with malnutrition suffer from iron deficiency
which increases risk of
maternal mortality and infants with low birth weight (Darnton-
Hill & Coyne, 1998).
The Poverty Obesity Paradox
Linkages between socio-economic status and obesity had been
established years ago (Sobal
& Stnkard, 1989). However, these connections vary between
countries and within countries;
there are gender variations (Wang, Y. 2001, Gnavi et al, 2000).
The thought that anyone

5. who is poor would also be overweight seems out of line. How is
this possible? Poverty is
relative and the poorest individuals living in the richest
countries live in poverty compared
to others in their country but those same individuals would
seem rich if compared to others
living in the poorest countries. This is not a complete
explanation and it does not address
the mechanisms at work making people overweight. A Gallup
poll (Mendes, 2010) found
an inverse trend between income and healthy behaviors of diet
and exercise and a positive
trend between income and smoking. Persons with lower income
are less likely to report
healthy behaviors than those with higher incomes. In the United
states minority persons,
except Asian Americans, were more likely to be obese (Flegal,
et al,2002; Pleis et al, 2009).
One can speculate realistically why income and healthy habits
are related. For example, if
a person must work long hours or multiple jobs, they may find it
difficult to find time to
prepare fresh foods. Fast food becomes an attractive option, in
that it is immediately affordable
and accessible. Also, income limits the geographic region
people can call home which impacts
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AND SOCIETY
where they can shop and what foods they will find available.
Persons who are poor may not

6. have the time, energy or land to plant their own garden.
Defining the Healthy Diet
The United States Government Dietary Guidelines focus on
balanced nutrition but some
caution that these guidelines do not help prevent obesity in
young adults (Zamora, Gordon-
Larsen, Jacobs, & Popkin, 2010). Determining what constitutes
an improved diet has been
simplified to the increased consumption of fruits and vegetables
(WHO, 2003). According
to the World Health Organization (2005), 2.7 million people die
each year as a result of low
fruit and vegetable consumption. The United States
Governmental Dietary Guidelines are
in line with the World Health Organization’s recommendations
about the importance of fruit
and vegetables. Fruits and vegetables are at the peak of their
nutritional value when just
picked, so the fresher the better.
Food Security
Food security is “defined as including both physical and
economic access to food that meets
people’s dietary needs as well as their food preferences” (WHO,
2011). Food security has
to do with availability, access and use. That is, there is enough
food consistently, it is afford-
able and people understand the basics of nutrition. (WHO,
2011). While some parts of the
world have issues around not having enough food, others have
too much food available and
resources to purchase the food, yet the outcome is still a poor
diet. In developed countries,
for example the United States, a kind of food shortage
impacting especially low income in-

7. dividuals, is what has been called ‘food deserts.’ According to
the United States Department
of Agriculture, a food desert is a geographic region where there
is limited access to affordable
and nutritious food. Kaplan (2009) found that poor
neighborhoods have more small grocery
stores and convenience stores, but less supermarkets. It is the
supermarket that has more
reliable, less expensive fresh fruit and vegetables. Others have
also found more fast food
restaurants and convenience stores within walking distance in
low income neighborhoods
(Moore & Diez, 2006). The United States Government Dietary
Guidelines note that eating
out increases weight gain and that one or more fast food meals
per week is strongly associated
with obesity (USDA, 2010). In a study of pregnant women and
nutrition, proximity to super-
markets was found to be positively associated with the quality
of their diet (Laraia, Siega-
Riz, Kaufaman, & Jones, 2004).
Factors Influencing Access to Food
The causes of food insecurity are varied. Food production is
sensitive to fluctuations in
weather conditions and the poorest countries have more
difficulty coping with these changes.
Food production and distribution is also influenced by economic
and political situations.
Even in-kind food aid can tip the balance of supply and demand,
by depressing food prices
and providing disincentives to farmers (Tadesse, & Shively,
2010). The causes of food
deserts are debated to be either an issue of supply or demand or
both (Bitler & Haider, 2011).
It may be that the cost of carrying perishable fresh fruits and

8. vegetables for small convenience
stores in some neighborhoods is too high which can influence
both supply and demand. Food
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SARAH BUILA
shortages and food deserts have the most devastating impact on
the most disadvantaged, the
poor, women, children and persons who experience racial or
ethnic oppression.
Dire Consequences
As discussed, the human cost for poor nutrition is far reaching
and is hardest hitting to vul-
nerable populations. There are also far reaching implications to
the health of the planet. The
way that we produce and distribute food has a direct impact on
global health. For example,
diets with increasing meat consumption, amounts to more
resources being used to produce
the food (FAO-UN, 2009). Livestock production is also a
contributor to greenhouse gases.
If we compromise the earth’s ability to grow food sustainably,
we will not be able to feed
the growing population. “Without change, the global food
system will continue to degrade
the environment and compromise the world’s capacity to
produce food in the future as well
as contributing to climate change and the destruction of
biodiversity” (Foresight, 2011, p.
10).

9. The Role of the Health Professional
If health care professionals are going to address the issues of
health outcome disparities,
much needs to be done to address the disparities in food access,
specifically access to fresh
fruit and vegetables. Nothing short of a systemic change is
required. Perhaps the first place
to start is at home with personal habits. This will require
learning what is most nutritious to
eat and what will have the smallest detriment on the global
system then transitioning personal
habits accordingly. Next, is making a commitment to our
patients and clients to support them
in acquiring the knowledge they need to be able to make healthy
diet choices. When necessary,
the health professional will be an advocate for increasing access
to fresh food. This means
supporting policies that increase agriculture production of food
worldwide. This means
supporting policies that encourage globally sustainable
production and which simultaneously
fight poverty. The implications go beyond the current political
and economical reasons for
food insecurity to a more global and sustainable effort.
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SARAH BUILA
About the Author
Sarah Buila
Sarah Buila, PH.D. is Assistant Professor and Undergraduate
Program Director at the School

14. of Social Work at Southern Illinois University, USA. She has
been teaching courses in re-
search, and health/mental health practice. She has over 16 years
of experience in mental
health practice and has long been interested in social justice
issues related to mental health,
race, religion, class and ability.
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AND SOCIETY
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