Hi everyone, my name is Avni Bannuru, and the title of my presentation is “Lack of Access to Nutrition in Low-Income North Carolina Communities– Implications and Interventions”. North Carolina is the 10th hungriest state in the country, with almost 604,000 food insecure households, with the root cause lying in poverty (“Hunger and Poverty in NC”, n.d). Today, I am going to be discussing this problem, its causes, its effects on health, and potential courses of action based on comparisons with similar issues in other nations, which will demonstrate that the lack of nutrition access faced by low-income communities in NC is exacerbated by, and further exacerbates, other disparity issues such as age, race, and transportation access, creating a vicious cycle in need of change. These factors play into higher rates of health issues like obesity and eating disorders, indicating a need for state-wide financial plans and community development, which will be explained further with this presentation.
I first want to discuss the various unique factors that can quantify nutrition access and health in these low-income populations, some of which we don’t immediately recognize as being associated with the issue but are nonetheless underlying factors. A study presented in 2017 by the International Journal of Environmental Research and Public Health assessed the association between food store environments and customer purchasing patterns as it relates to nutrition and diet in Eastern North Carolina. Some of the major observations of the study were that “…those who live closer to farmers’ markets(1, 2) and supermarkets(3, 4) generally have lower BMI’s… Also, those who shopped at farmers’ markets were older on average (P = 0·018), less likely to be black (P = 0·001) and less likely to be students (P = 0·018)” (Pitts, 2013, p. 1944-1952). This quantitative data collection highlights key environmental factors such as distance to healthy stores, seasonality, business hours, age, and race that can be correlated to BMI and blood pressure patterns. These factors are also tied to low socioeconomic status. For example, students and other low-income community members may not have access to transportation, disparately affecting their ability to commute the distance to healthy food stores, or they may work long hours at minimum wage, disparately affecting their ability to meet store business hours.
Extending the idea that low-income individuals spend more time working, giving them less free time to focus on themselves, trends presented by the London Nutrition Journal demonstrate that “…lower income individuals appear to be increasingly less likely to cook, suggesting a greater reliance upon foods that require little preparation…” (Smith, 2013, p. 1-11). These foods that require little preparation are often more costly, escalating poverty issues, and high in sodium and artificial additives that replace the raw produce, lean proteins, and whole grains that are key to a healthy diet. Lastly, I want to discuss some less commonly considered actions from the perspective of grocery stores that play a role in diet patterns. In a study on urban food deserts, the researchers observed that prices for junk foods are typically lower in supermarkets, subjecting the low-income community to bulk purchasing and greater consumption. Additionally, they observed that high-price stores actively marketed healthy foods, while low-price stores actively marketed junk foods (Ghosh-Dastidar, 2014, p. 587–595). Marketing by stores are efforts that greatly affect the way people shop and is often the extent of people’s knowledge about nutrition, especially for those with limited time as mentioned before, and thus choosing marketing materials wisely is incredibly important in promoting positive nutrition education.
Now that these factors contributing to the lack of nutrition access have been established, I want to further delve into the ways in which these nutrition disparities result in varying health outcomes for different types of communities. Looking at a study on “the global burden of malnutrition” in the British Medical Journal, we can understand largely studied nutrition-related health issues before relating them to North Carolina on a smaller scale. The study explains that “although absolute obesity prevalences are still higher among the wealthier, obesity rates are growing much faster among the socioeconomically vulnerable.” These growing rates indicate a problem that is progressing, raising concerns and needs for action to reverse the worsening of the issue. This study also interestingly points out that “Nutritional disparities and the double burden of nutrition must be considered from a life course perspective” as their research “has documented the intergenerational transmission of both stunting and obesity” (Perez-Escamilla, 2018, p. 6-9). This emphasizes how failure to take action deepens the root of the problem especially for marginalized groups and is eye-opening to the idea of the double burden of nutrition, which is the simultaneous existence of both undernutrition and obesity. This perfectly describes the health situation facing low-income North Carolina communities, in which “More than 2 million people, including over 435,000 children under the age of 15, live in areas where residents are suffering with diet-related disease and can’t easily access healthy food” (The Food Trust, 2018, p. 2-3).
Analyzing this cause-and-effect relationship in nutritional health disparities leads me to address the question of what specific interventions have been studied locally and globally that can applied to take action here in North Carolina. According to a community analysis done by The Food Trust, the NC food insecurity statistics demonstrate a need for a statewide financing program to encourage healthy food retail development in North Carolina (The Food Trust, 2018, p. 4). This is at the forefront of interventional action because of how clear it is that characteristics of grocery stores, such as marketing, hours, and location, are the root of the most prevalent factors limiting nutrition access, so starting at this core appears to be most beneficial. A potential idea that has been observed in other nations like the UK is that “lowering prices of healthy foods through a rebate program led to increases in purchases of healthy foods and decreases in purchases of non-nutritious foods” .” (Ghosh-Dastidar, 2014, p. 587–595).
After looking at all of these causing factors, effects, and potential interventions, it is clear that action needs to be taken in North Carolina to address this critical issue of a lack of access to nutrition in low-income populations. The potential interventions discussed target reform of grocery stores which are central to nutrition access, but only scratch the surface, prompting further research. Without research and intervention, these disadvantaged communities will continue to be disadvantaged in the vicious cycle of low economic development leading to low income and food insecurity, leading to poor health outcomes and higher health costs that they cannot fulfill, while advantaged communities continue to advance disparately.
The Food Trust, The North Carolina Alliance for Health. (2018). The Need for Healthy Food Access in North Carolina. The Food Trust. http://thefoodtrust.org/uploads/media_items/food-for-every-child-north-carolina.original.pdf
Ghosh-Dastidar, B., Cohen, D., Hunter, G., Zenk, S. N., Huang, C., Beckman, R., & Dubowitz, T. (2014). Distance to store, food prices, and obesity in urban food deserts. American Journal of Preventive Medicine, 47(5), 587–595. https://doi.org/10.1016/j.amepre.2014.07.005
Inter-Faith Food Shuttle. (n.d.). Hunger and Poverty in NC. Inter-Faith Food Shuttle. https://www.foodshuttle.org/hunger-in-nc.
Jilcott Pitts, S., Wu, Q., McGuirt, J., Crawford, T., Keyserling, T., & Ammerman, A. (2013). Associations between access to farmers’ markets and supermarkets, shopping patterns, fruit and vegetable consumption and health indicators among women of reproductive age in eastern North Carolina, USA. Public Health Nutrition, 16(11), 1944-1952. doi:10.1017/S1368980013001389
Perez-Escamilla, R., Bermudez, O., Buccini, G. S., Kumanyika, S., Lutter, C. K., Monsivais, P., & Victora, C. (2018). Nutrition disparities and the global burden of malnutrition. BMJ, k2252. https://doi.org/10.1136/bmj.k2252
Smith, L. P., Ng, S. W., & Popkin, B. M. (2013). Trends in US home food preparation And consumption: Analysis of national NUTRITION surveys and time use studies FROM 1965–1966 TO 2007–2008. Nutrition Journal, 12(1), 1–11. https://doi.org/10.1186/1475-2891-12-45
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