27 Only a mirage: searching for healthy options in a food desert
27 Only a mirage: searching for healthy options in a food desert
Christine Chim, PharmD, BCACP
Natalie DiPietro Mager, PharmD, PhD, MPH
Taylor Schooley, PharmD candidate
Sneha Srivastava, PharmD, BCACP, CDCES, DipACLM
Topic Area
Health disparities
Learning Objectives
At the end of this case, students will be able to:
- Define food insecurity and its potential causes
- Explain how food insecurity may impact patient outcomes
- Recommend appropriate food choices for a patient living in a food desert
- Identify key therapeutic considerations and counseling points for a patient with food insecurity
Introduction
Food insecurity is defined by the United States Department of Agriculture (USDA) as “a lack of consistent access to enough food for an active, healthy life.”1 There are various patterns of food insecurity, and it may impact patients uniquely and intermittently. The SEARCH mnemonic (Screen, Educate, Adjust, Recognize, Connect, Help) is one way to ascertain who may be experiencing food insecurity and ensuring appropriate steps are taken to address the issue.2
One driver of food insecurity may be socioeconomic status and limited ability to purchase healthy or fresh foods. A validated two-item screening tool may be used to ascertain whether a patient is impacted by this type of food insecurity: (1) within the past 12 months we worried whether our food would run out before we got money to buy more, or (2) within the past 12 months the food we bought just didn’t last, and we didn’t have money to get more.2 If the patient responds with an affirmative answer to either of these questions, further exploration about the patient’s circumstances is necessary.
Another contributing factor to food insecurity is living in a food desert. The term “food desert” is a term used today that was adapted from the United Kingdom to reference neighborhoods that are deprived of food due to expenses and unavailability.3,4 A food desert is defined as “a geographic area, typically at the neighborhood scale or greater, in which residents experience physical and economic access barriers to affordable and healthful food procurement.”5 In the Food, Conservation, and Energy Act, the USDA was directed to assess areas in the nation where Americans had limited access to food that was affordable and healthy. It was concluded that 23.5 million people live in low-income locations greater than one mile from a large grocery store or supermarket, with 11.5 million of these people qualifying as low-income themselves.6,7
Households of low income and ethnic minorities rely heavily on the food environment in their immediate neighborhood.8 Inadequacies such as transportation and socioeconomic status limit individuals to having their foods supplied by a convenience store or retailer in which food options are packaged and non-perishable, compromising the nutritional value.5 Living in a food desert is a social determinant of health (SDH/SDOH) and is linked to higher incidences of obesity, diabete