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LETTER |
Correspondence: Requests for reprints should be sent to Steven C. J. Cummins, BSc, PhD, Medical Research Council Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow, G12 8RZ, UK (e-mail: steven{at}msoc.mrc.gla.ac.uk).
Morland et al suggest that the absence of a neighborhood supermarket is associated with poor adherence to healthy eating patterns compared with those in neighborhoods with one or more supermarkets.1 The article also suggests that this relationship is particularly pronounced in Black neighborhoods. In the United Kingdom, areas where there is little or no food retail provision have been described as "food deserts," and there is a tradition of research in this field.2–4 Food deserts may affect population health in a number of ways, most importantly, by establishing barriers to healthy eating through restricting individual and household access to the food price and availability benefits of the modern retail economy. These barriers may have particular impacts upon low-income households, single parents with children, the elderly, and those with mobility problems.5
Food deserts research in the United Kingdom has culminated in several area-based policy initiatives that have sought to improve physical retail access in low-income communities. However, debate over the interpretation and extent of the evidence base for the existence of food deserts began after a recent study suggested that research findings (including those cited by Morland et al.1) may have been misinterpreted by food activists and policymakers.6 In the United States, the evidence base for the existence of food deserts is also ambiguous, as work has produced conflicting results about whether a grocery store "gap" exists between rich and poor urban neighborhoods.7–9
One problem with studies such as that described by Morland et al. is that they fail to establish a causal relationship between the presence or absence of a supermarket and an improvement in healthy eating patterns. However, two separate but similar projects being undertaken in the United Kingdom (in Glasgow and Leeds) are seeking to remedy this by treating the building of a new food supermarket, in a neighborhood previously described as having poor food retail access, as a "natural experiment." Initial results from the Leeds study suggest that building a supermarket in a retail-poor area may have direct and indirect beneficial effects on health through a significant increase in fruit and vegetable consumption, tripling the use of walking as a method of transport, and reducing the stress of complex coping mechanisms to access food stores.10 Whether this demonstration of a causal relationship could be replicated in the United States remains to be seen. It would, however, be an important step forward for research in this field.
References
1. Morland K, Wing S, Diex-Roux, A. The contextual effect of the local food environment on residents’ diet: the atherosclerosis risk in communities study. Am J Public Health.2002;92:1761–1767.
2. Piachaud D, Webb J. The Price of Food: Missing Out on Mass Consumption. London Suntory-Toyota International Centre for Economics and Related Disciplines: London School of Economics and Political Science; 1996.
3. Cummins S, Macintyre S. The location of food stores in urban areas: a case study in Glasgow. Br Food J. 1999 101:545–553.
4. Cummins S, Macintyre S. A systematic study of an urban foodscape: the price and availability of food in Glasgow. Urb Stud. 2002;39:2115–2130.
5. Westlake T. The disadvantaged consumer: problems and policies. In: Bromley RDF, Thomas CJ, eds. Retail Change, Contemporary Issues. London: UCL Press; 1993:172–191.
6. Cummins S, Macintyre S. Food-deserts: evidence and assumption in health policy making. BMJ.2002;325:436–438.
7. Alwitt LF, Donley TD. Retail stores in poor urban neighborhoods. J Consumer Aff.1997;31:139–164.
8. Hayes LR. Are prices higher for the poor in New York City? J Consumer Aff. 2000;23:127–152.
9. Morland K, Wing S, Diez-Roux A, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002;22:23–29.[ISI][Medline]
10. Wrigley N, Warm D, Margetts B. Deprivation, diet and food retail access: findings from the Leeds ‘Food-Deserts’ Study. Env & Plan A. 2003;35:1:151–188.
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