New study unpacks the many pathways between healthy food access and urban environments

The research by Yeeli Mui, PhD, a post-doctoral fellow in UB's Food Systems Planning and Healthy Communities Lab and Community for Global Health Equity, documents a web of interrelated socioeconomic, cultural and contextual influences in relation to food retailer and consumer choices around healthy eating in challenged urban neighborhoods. The article was published in the May 2019 issue of PLOS ONE, journal on the social applications of scientific research.

Prior research has long documented the correlative connections between socioeconomic status and racial composition to variability in the food environment, eating behaviors and obesity risk. Yet questions remain about the mechanisms through which these and other neighborhood characteristics operate.

In partnership with Ellis Ballard, associate director of the Social System Design Lab at Washington University in St. Louis, Mui applied community-based system dynamics modeling to document reinforcing and negative feedback loops in the urban food environment, ultimately revealing crucial levers for policy action in food systems planning.

The study focuses on the 7th District of Central West Baltimore, where there is limited availability of fresh and healthful foods, and where crime, poverty and vacancy rates are among the city’s highest.

Working with local stakeholders, including the neighborhood-based Whitelock Community Farm and Reservoir Hill Improvement Council, Mui convened a two-day group model building workshop of 18 storeowners, community residents, city government officials and local nonprofit representatives. Drawing from their lived experiences, participants mapped relationships among a diverse mix of vectors, for instance, imprisonment of community and family members, food stocking at neighborhood stores, and the effect of time, money and information on the value of different food choices.

Ballard says the study is a powerful new application for the community based systems model, which draws from the premise that people embedded in the day-to-day experience of a complex problem are best positioned to describe the system structures behind it.

“By starting from the lived experiences of those residing and working in Central West Baltimore,” he says, “the group was able to negotiate a rich and complex model that transcends traditional domain boundaries of public health, urban planning, criminal justice, or community develop, and reveals a new perspective on food access.”

One finding draws attention to incarceration and its multi-layered relationship with economic opportunity and family health. Disproportionately burdening communities of color, incarceration disrupts ties with mentors and the stable family structures needed to support and enable young people to thrive.

The study also reveals a self-perpetuating cycle related to storeowners’ perception of consumer demand – and therefore economic risk – in stocking healthy options. With limited time and resources, residents gravitate toward more cost-effective, unhealthy options. To meet this demand, storeowners maintain and market the stock of unhealthy foods. Consumers are then even less likely to purchase the limited stock of healthy options – all of which perpetuates storeowners’ perceived level of risk in stocking more diverse and higher quality healthy food options.

Mui’s study is also one of the first to report on the interconnected mechanisms through which crime impacts the neighborhood food system and healthy food access. Participants revealed that in some cases, illicit activities in fact support corner stores (which typically offer a lower diversity of healthy food) by paying “rent” in exchange for a safe haven where illegal acts may be shielded from public view and law enforcement.

The connection between crime and neighborhood businesses shares parallels with existing literature on alcohol outlets as crime generators in communities. Mui says this demonstrates a need for future ethnographic studies to define the mechanisms and potential co-dependency between crime and establishments deemed less favorable for community health.

The study provides actionable insights for community groups such as the Reservoir Hill Improvement Council and Whitelock Community Farms, which are already working to source local produce in stores, increase knowledge of healthy food among caregivers, and engage schools to promote healthy eating behaviors.

 “A critical takeaway from this study is that the challenges related to shopping for healthy food or eating healthy food involve many moving parts, beyond the individual or even beyond the individual food retailer,” says Mui. “To do a better job of addressing inequities in healthy food access, I think it’s important to ask why questions. Why is a particular individual eating or not eating healthier food, and why is a particular food retailer selling or not selling healthier food options?”

Mui advocates for further research on broader social and economic forces that shape urban food environments – and opportunities to strengthen the supply chain of a greater range of healthy food options, including those with a longer shelf life. She says the study also lays the groundwork for the next step –building a simulation model that could reveal stronger and weaker leverage points for creating change in the neighborhood food system.

The research was funded by the Johns Hopkins Urban Health Institute, Brown Community Health Scholarship Program, and the Centers for Disease Control and Prevention Special Interest Projects.