|Posted on December 4, 2020 at 5:45 PM|
Neighborhood Disparities in Access to Healthy Foods and Their Effects on Environmental Justice
Angela Hilmers, MD, MS,corresponding author David C. Hilmers, MD, MPH,corresponding author and Jayna Dave, PhD
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Environmental justice is concerned with an equitable distribution of environmental burdens. These burdens comprise immediate health hazards as well as subtle inequities, such as limited access to healthy foods.
We reviewed the literature on neighborhood disparities in access to fast-food outlets and convenience stores. Low-income neighborhoods offered greater access to food sources that promote unhealthy eating. The distribution of fast-food outlets and convenience stores differed by the racial/ethnic characteristics of the neighborhood.
Further research is needed to address the limitations of current studies, identify effective policy actions to achieve environmental justice, and evaluate intervention strategies to promote lifelong healthy eating habits, optimum health, and vibrant communities.
ENVIRONMENTAL JUSTICE HAS been defined as
fair treatment and meaningful involvement of all people regardless of race, ethnicity, income, national origin, or educational level in the development, implementation, and enforcement of environmental laws, regulations, and policies.1(p1)
Fair treatment signifies that “no population, due to policy or economic disempowerment, is forced to bear a disproportionate exposure to and burden of harmful environmental conditions.”1(p1) The concept of environmental justice, which has its roots in the fight against toxic landfills in economically distressed areas, can be similarly applied to the inequitable distribution of unhealthy food sources across socioeconomic and ethnic strata.1 The neighborhood environment can help promote and sustain beneficial lifestyle patterns or can contribute to the development of unhealthy behaviors, resulting in chronic health problems among residents.2–4 The higher prevalence of obesity among low-income and minority populations has been related to their limited access to healthy foods5–18 and to a higher density of fast-food outlets and convenience stores where they live.9,19–21 These environmental barriers to healthy living represent a significant challenge to ethnic minorities and underserved populations and violate the principle of fair treatment.
Several studies have investigated disparities in the distribution of neighborhood vegetation,22,23 the proximity of residences to playgrounds,24 and the accessibility of supermarkets and grocery stores,25,26 but fewer have examined access to fast-food outlets and convenience stores as a function of neighborhood racial and socioeconomic demographics. To our knowledge, our review is the first to expand the focus of environmental justice from environmental hazards and toxic exposures to issues of the food environment by examining research on socioeconomic, ethnic, and racial disparities in neighborhood access to fast-food outlets and convenience stores.
We reviewed studies of differences in accessibility of fast-food outlets and convenience stores by the socioeconomic and racial/ethnic characteristics of neighborhoods. With the assistance of an experienced health science librarian, we conducted searches in the MEDLINE, PubMed, PsycINFO, EBSCO Academic Search Premier, and Scopus databases. Key words were “neighborhood deprivation,” “food environment,” “food sources,” “fast-food restaurants,” “convenience stores,” “bodegas,” “disparity,” “inequality,” “minorities,” “racial/ethnic segregation,” and “socioeconomic segregation.” We included only original, peer-reviewed studies published in English between 2000 and 2011. Comments, editorials, dissertations, conference proceedings, newsletters, and policy statements were excluded. We also excluded studies that focused on methods and measurements, did not examine socioeconomic or racial/ethnic characteristics of the neighborhood, or used schools as a proxy for neighborhood environment.
Our search identified 501 unique citations; after detailed inspection, we selected 24. The primary reasons for exclusion were irrelevant outcomes or comparisons (n = 316), focus on dietary behavior (n = 96), and methodology studies (n = 65). We defined fast-food outlets as
take-away or take-out providers, often with a ‘drive-thru’ service which allows customers to order and pick up food from their cars; but most also have a seating area in which customers can eat the food on the premises (http://www.merriam-webster.com).
Examples of fast-food outlets were fast-food restaurant chains, take-away or carry-out establishments, and small local fast-food businesses. We defined convenience stores as
retail stores that sell a combination of gasoline, fast foods, soft drinks, dairy products, beer, cigarettes, publications, grocery items, snacks, and nonfood items and have a size less than 5000 square feet.27(p996) .......... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482049/
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