nursing schoolWhen it comes to health, you are what you eat, as the adage goes. But many Americans have little choice in the matter, with race being an even bigger determinant than poverty.

Results of a recent study shed new light on factors underlying well-known and well-documented health disparities across racial and ethnic groups. According to lead researcher and Johns Hopkins University School of Nursing assistant professor Kelly M. Bower, PhD, MSN/MPH, RN, and colleagues from the Bloomberg School of Public Health, findings suggest that, when compared with other neighborhoods and without regard to income, predominantly black neighborhoods have the most limited access to supermarkets and to the healthier foods such markets sell.

The study explored food store availability in over 65,000 rural and urban census tracts across the country, comparing the numbers of supermarkets with more than 50 employees, grocery stores, and convenience stores in communities with varied economic and racial compositions. The researchers found that the more impoverished a neighborhood, the fewer the number of independent or chain supermarkets and the less access to fresh fruits, vegetables, low-fat milk, high-fiber foods, and other healthy meal and snack options. The same finding holds true for all predominantly black neighborhoods—whatever the economic status—when compared with predominantly white or Hispanic communities.

The researchers noted that education about positive food choices, while important, is likely of limited help when people lack access to supermarkets and other sources of healthy foods. Local interventions based on knowledge of the local food environment are most likely to be successful. They note that there are local initiatives around the country currently working to promote access to health food options but that they need to be evaluated so we can better understand their successes and challenges. Food access initiatives include mobile grocery stores, ordering foods from supermarkets online for delivery with food stamps, and tax incentives for supermarkets to locate in low-income minority communities.

“Race, ethnicity, income, and geography all play a role in access to quality foods and the opportunity to make healthy choices,” Bower says. “To address health disparities, we need to understand and alter the factors that contribute to them. The availability of high-quality, healthy food could be one of those factors that is within our power to alter.”

[“The intersection of neighborhood racial segregation, poverty, and urbanicity and its impact on food store availability in the United States” was published online in Preventive Medicine in October 2013.]