Dean's Blog

In my last blog I wrote about food insecurity and touched on “food deserts” and “food literacy”. The “formula” for a good diet that I proposed was -

Financial Resources + Food Access + Food Literacy = A nutritional and balanced diet.

Addressing subpar access to food has received an enormous amount of attention in recent years. According to the U.S. Department of Agriculture (USDA food deserts), in 2009 over 23 million Americans were reported to reside in “food deserts” – “low-income census tract[s] where a substantial number or share of residents has low access to a supermarket or large grocery store” – this includes much of our city of Camden.  Notably, the phrase “food desert” was supposedly first used in west Scotland in the early 1990’s by a public housing resident.

Take a few minutes and visit the USDA’s “Food Desert Locator” site here and type in a place nearby your home – are you surprised by what you found?  A map of the U.S. shows that roughly 10% of the country qualifies as a food desert.

An article from “The Economist” last summer suggests that this may not be entirely what it seems, however. Last year, the number of people in food deserts was reported to be 13.5 million, an appreciable drop but one derived by changing the defining distance from a supermarket in rural areas from 1 to 10 miles thereby “increasing” access without really changing anything. Some have stated that the inclusion of proximity to “a supermarket or grocery store” in the definition ignores the large number of small food markets and farm stands – a point well-taken. But there is more to this story that involves having the knowledge to appropriately select healthy food whether at a large national retail chain store or the mom-and-pop market down the street.

I recently came upon a great definition of “food literacy” – “the ability to organize one’s everyday nutrition in a self-determined, responsible and enjoyable way.”  The issue of “food literacy” compounds the problems of purchasing power and access. If one doesn’t understand what “healthy” versus “unhealthy” food is, then the informed purchase of good food is impossible.

How do we begin to develop a “food literate” society, especially in economically and educationally challenged area rife with low purchasing power and less than optimal access? To quote author Steven Covey, I think we need “to begin with the end in mind.”

If the goal is equip food purchasers with the information to make healthy choices, we must begin in our schools. Perhaps the most important part of “food literacy” is “literacy”, especially in those communities where reading skills are not what they should be. How can one interpret complicated food nutrition labels that adorn most foods if you can’t read and understand the words?

Second, comprehension about the basics of nutrition and health is essential and also needs to begin no later than elementary school. Additive to this are programs that help educate the parents of these students with the pertinent facts of food selection.

Finally, school lunches offer a wonderful opportunity beyond the provision of good healthy food.  Lunch can be a “learning moment” to eat and learn about what’s on the menu; these real life experiences can be very powerful.

While the “equation” for good nutrition may be relatively simple, the “solutions” are multi-factorial and complex.  For success, we as a country must address all three “variables” to get to this crucial answer.

Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University

It is irrefutable that fresh, wholesome food is necessary for good health. It is similarly undeniable that many people in our country lack the ability to acquire good food. Tragic but true in a land as well to do as the United States. Recently, new information has emerged about this not so new problem, a problem with dramatic health consequences. We all need to pay attention.

The Institute of Medicine (IOM) recently released an important report, “Hunger and Obesity: Understanding a Food Insecurity Paradigm” (IOM article). This extremely comprehensive publication arose from a meeting convened in November, 2010 by the IOM on behalf of the Department of Agriculture’s Food and Nutrition Service.

But let’s start with the taxonomy surrounding the spectrum of “Food Security” (access to nutritional, safe food coupled with the ability to acquire these foods in a socially acceptable way) at one end to “Hunger” (the uncomfortable painful sensation due to lack of food) at the other. Toward the “Hunger” end of the scale is “Food Insecurity”, defined as “limited or uncertain ability to acquire acceptable foods in socially acceptable ways”.

At the very least, this IOM treatise summarizes much of what we already know about the problem. While perhaps intuitively obvious, the data are stark reminders. Before 2008, the prevalence of food insecurity in the U.S. was between 10-12%, highest among Latinos and African Americans. In 2008, this jumped to 15% – the correlation with the beginning of the recession is striking – where it has remained since.  Food insecurity is highest in new immigrants, not surprisingly; imagine the challenge in arriving in a new land and not having enough to eat, perhaps coupled with a dim chance of employment on the horizon. Interestingly, however, food insecurity is not synonymous with poverty; the definition of food insecurity includes challenges in access to and acquisition of healthy foods, regardless of one’s ability to pay.

Let’s go back for a moment to the title of the IOM report – “Hunger and Obesity”.  Hunger AND Obesity? Yes. While the association of food insecurity and obesity in children and adolescents is somewhat variable among published studies, healthy nutrition is obviously based on not just quantity, but quality. So it does appear that obesity is a problem among the food insecure. Of note, among those with food insecurity, the prevalence of lower obesity is observed in the persistently poor who lack both food quantity and quality; food insecurity among those living below the poverty line approaches 40%.

Negative health outcomes arising from food insecurity exist: hypertension and elevated lipid levels are increased, but also diabetes. In those homes with significant food insecurity, the risk of diabetes is twice that of households with no food issues. Additionally, the finding of increased stress and depression among the food insecure is no surprise either.

Having the financial wherewithal is only part of the cause of food insecurity. A big part but, nonetheless, only a part. In fact, it is very possible to be food insecure in the United States where causality is significantly related to access – easy, convenient and safe access to acquire healthy, affordable food. Areas without such access are designated by another new phrase – Food Deserts – defined by the USDA as “low-income census tract[s] where a substantial number or share of residents has low access to a supermarket or large grocery store”.   By the way, much of CMSRU’s own neighborhood in Camden, NJ, has been identified as one of these Food Deserts (see the USDA’s Food Desert Locator here).  And there is one more important variable – “Food Literacy – that is, having enough of an understanding of nutrition and food to select appropriate food items.  In an upcoming blog, I’ll be writing more about food deserts and food literacy.

So perhaps the “formula” is this:

Financial Resources + Food Access + Food Literacy = A nutritional and balanced diet that will support good health.

Shouldn’t this be possible? As health professionals, we have an obligation to our communities to help ensure that the most fundamental needs are met – the needs that will help foster well-being. The health and human consequences of doing less are not acceptable.

Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University