Access to Healthy Food Choices

Access to Healthy Food

Food insecurity is a household-level economic and social condition of limited or uncertain access to adequate food. The defining characteristic of very low food security is that, at times during the year, the food intake of household members is reduced and their normal eating patterns are disrupted because the household lacks money and other resources for food.

Individuals and families living in food deserts are at risk for experiencing food insecurity. Food deserts, according to the U.S. Department of Agriculture (USDA), are areas with large proportions of households with low incomes, inadequate access to transportation, and a limited number of food retailers providing fresh produce and healthy groceries for affordable prices. The USDA found that 23.5 million people live in low-income areas that are further than 1 mile from a large grocery store or supermarket, and that 11.5 million of these people have low incomes themselves.

Another USDA report noted these factors contributing to food deserts:

Higher levels of poverty, regardless of rural or urban designation
Reduced vehicle availability and use of public transportation
Higher the percentage of minority population, except in very dense urban areas

Of all these factors, the 2012 researchers found that concentrated poverty and minority populations emerge were the critical factors in determining low access to healthy food. Compounding the issue is that environments characterized by low income and education levels and high unemployment are most likely unattractive markets for supermarkets and grocery stores. The researchers suggested that public policies may help to alleviate the most dire consequences of living in a food desert by lowering other barriers to access, such as providing better public transportation to enable access to retailers in surrounding areas or addressing education and employment shortcomings directly. It may also be feasible to encourage smaller stores in food deserts to carry healthier products.

Federal food subsidy programs

Each of these programs described below are administered by the USDA’s Food and Nutrition Service (FNS).

Supplemental Nutrition Assistance Program (SNAP), offers nutrition assistance to eligible, low-income individuals and families. FNS works through its nationwide network of field offices to monitor those stores participating in SNAP.
Summer Food Service Program (SFSP) is a federally-funded, state-administered program. SFSP reimburses program operators who serve free healthy meals and snacks to children and teens in low-income areas during summer months when they are unable to access the free or reduced cost meals provided through schools.

Women, Infants, and Children (WIC) provides federal grants to states for nutrition education, supplemental foods, and health referrals for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk.
The Seniors Farmers’ Market Nutrition Program (SFMNP) provides low-income seniors with access to locally grown fruits, vegetables, honey and herbs. Operated through federal grants to states, the District of Columbia, U.S. Territories, and federally-recognized tribal governments.

Examples of other food programs

Farmers markets provide access to healthy, nonprocessed, fruits and vegetables. Farmers markets in all 50 states now accept SNAP benefits. According to USDA FNS data, 7,377 farmers and farmers markets across the country were authorized to accept SNAP benefits in 2017; in 2017, more than $22.4 million SNAP benefits were redeemed at farmers markets. Below are examples of farming communities working to provide low-cost fresh produce to low-income familes:

Front Line Farming provides high quality, organic food on a sliding scale sales at farm stands and donates food to a variety of non-profit partners.
Go Fresh Mobile Farmer’s Market serves 12 low-income neighborhoods in Springfield, Mass., with weekly stops at locations including subsidized housing complexes, senior centers, and community clinics.
Arcadia’s Mobile Market sells everything from broccoli to turmeric root to people who live in food deserts. Anyone using SNAP, EBT, and WIC benefits to purchase food gets double for the price.

The Geisinger Health Plan in Pennsylvania created a program targeting patients with type 2 diabetes after research showed that 1 in 4 of these patients are food insecure. Geisinger modified its electronic health records EHR) to include a screening tool to identify patients who are food insecure. These patients receive a “prescription” for Geisinger’s Fresh Food Pharmacy. In addition to diabetes education, each week patients receive enough food to prepare healthy and nutritious meals for their whole family, twice a day for five days (10 meals per week). Geisinger has located its Food Farmacys at three of its community hospitals.
Kaiser Permanente hosts farmers markets outside its hospitals and medical centers. The number of Kaiser Permanente markets has climbed to more than 45, with locations California, Hawaii, Oregon and Maryland.

The Twin Cities Mobile Market (TCMM) is a grocery store on wheels developed to increase access to healthy, affordable foods in under-resourced neighborhoods. the Mobile Market sells a variety of fresh fruits and vegetables, dairy, meats, and staple dry goods year-round at below-market prices. The program was designed to address local inequities in healthy food access by bringing fresh, affordable food to neighborhoods with few grocery stores or where residents struggle to afford fresh food prices. TCMM is a program of the Amherst H. Wilder Foundation working to improve community health and well-being. TCMM launched in 2014 and became fully operational in January 2015, stopping regularly at 18 different sites across Saint Paul. The project began by first transforming an unused Metro Transit bus into a mobile market to deliver healthy foods.

Role of public transportation in food access

Having sources of healthy food located in a community is one aspect of combatting food insecurity; the other is providing transportation to healthy food sources outside the community. Most public transportation services design stops at major food grocery chains, and many have designed specific grocery runs. A sampling of systems that have these dedicated services is given below:

Flint, Michigan
Flint MTA’s “Rides to Groceries”
Vancouver, Washington
C-Tran’s Shopping Shuttle
York, Pennsylvania
Rabbit Transit’s Giant Shuttle
Framingham, Massachusetts
MWRTA’s Grocery shuttles (Temporary during the COVID-19 pandemic)

Some other steps public transportation can take to improve access to healthy food are:

Adjust bus routes to serve sites of farmers markets
Address bag limitations — many transit agencies limit the number of bags individuals can bring on board to those that will fit at their feet as they sit on the bus
Make it easier to carry groceries on transit vehicles, such as this design for a grocery bin that could be mounted onto the front of buses
Co-locating healthy food access at transit hubs, such as the Fresh MARTA Market (Atlanta, GA),

For further investigation . . .

The Wheels on the Bus Go to the Grocery Store

This fact sheet outlines the role of transit agencies in improving food access, offers examples from transit agencies across the country, and shares solutions that will allow transit agencies to create or strengthen the connection between neighborhoods and grocery stores.

Transportation Strategies to Connect Youth with Summer Food Programs

This resource explores potential collaboration strategies mobility managers, transportation providers, and summer meal sites can pursue to reduce the number of children who go hungry each summer. Concludes with suggested strategies that mobility management professionals can use to support access to summer food programs within their communities.

Rides to Meals Webinars

Part 1, titled Strategies and Resources to Support Connections between Summer Food Service Programs and Transportation, explored ways in which public transit programs can partner with FNS-funded summer food programs to ensure youth have access to nutrition over the summer months, showcasing two examples from Texas. Part 2, titled Strategies to Connect Youth with Summer Food Service Programs, featured two communities as well as a short review of other strategies featured in an upcoming NCMM Mobility Management In Practice brief on youth food access.

Access to Healthy Food Choices