Most of us have heard of food deserts but what about food swamps? What do these terms really mean and why does it matter?
This month the Journal of the American Medical Association (JAMA) oncology division reported on a study (see below) that confirms what natural health practitioners have known for many years – fast food and ultra processed ‘food’ causes cancer, and there are profound socio-economic inequalities in how this plays out in society.
A ‘food desert’ is a geographic area or region where ready access to nutritious foods, especially fresh fruits and vegetables, is lacking due to the absence of farm shops or grocery stores within convenient traveling distance. This is exacerbated by financial lack (inability to afford healthy foods or the gas or transit fees to get them), inadequate housing (inability to properly prepare fresh foods in the home), time poverty (working two or three low paid jobs to make ends meet and not having time to get to the stores far away, or the time to prepare heathy foods in the home), and all of these are conditions more often seen in poor, immigrant or other marginalized groups.
Studies suggest that wealthy districts have three times as many supermarkets as poor ones do, that white neighborhoods contain an average of four times as many supermarkets as predominantly black ones do, and that grocery stores in African-American communities are usually smaller with less selection.
Thus, a defining characteristic of food deserts is socio-economic: they are most commonly found in immigrant or predominantly black and brown communities and low-income areas. The US Department of Agriculture has reported that almost 2.5 million people (almost 2.5% of US households) live more than one mile away from a supermarket and do not own a car. Even where transit options exist, decent grocery stores may be far apart, requiring several buses or trains, with commensurate costs in times and fares.
And, of course, this is not a problem confined to America. In 2012, almost 13% of Canadian households experienced food insecurity defined as “inadequate or insecure access to food because of financial constraints”, and this has only worsened over the past decade.
As if that wasn’t challenging enough, government subsidies to big AgriBiz who grow mostly corn and soy, or mass produce meat animals in inhumane conditions requiring huge input of drugs, has skewed the food markets so that healthier foods are generally more expensive than fast foods and processed foods, and this is especially so in food deserts.
For instance, while the overall price of fruits and vegetables in the US increased by nearly 75 percent between 1989 and 2005, the price of fatty foods dropped by more than 26 percent during the same period.
So much for food deserts – what about food swamps?
These are more common in central urban areas and are defined as regions with some access to healthy food options but that also features an overabundance of fast food outlets and unhealthy food choices.
This matters because humans evolved as hunters and gatherers, always looking for the best caloric return for the least energy expenditure. This behavioural trait has been dubbed the ‘thrifty gene’ and today it predisposes us to choose foods of higher caloric value than our ancestors could ever have dreamed of e.g. the iced donut not the apple. So even where healthier choices exist, we are hard wired to crave sweets – as any mom with a kid in a grocery store can attest to when approaching the check out and facing a barrage of sweets and crisps, deliberately placed there to tempt us all.
In Canada, chronic diseases, including diabetes, cardiovascular disease and cancer, represent 89% of all deaths, and all of those people suffered pain and morbidity during their (shortened) lives. A significant proportion of those deaths are a result of poor diet choices and reduced vegetable and fruit consumption alone is estimated to cost the economy over $3.5 billion annually per year through direct healthcare costs and losses in productivity.
The profound lack of phytonutrients in the average diet due to deficient fruit and vegetable intake is only compounded by the lack of any nutrients in the foods we replace them with. An abundance of research over the last few years has confirmed that, no great surprise, ultra processed food is bad for us. A meta analysis of studies published in the British Journal of Nutrition in 2021 reported that the higher the consumption of ultra processed food, the greater the risk of obesity, metabolic syndrome, low HDL-cholesterol levels, cerebrovascular disease, depression and all-cause mortality. Another study in 2022 linked ultra processed food to diabetes, cancer, and gastrointestinal diseases.
In conclusion then, we would all do well to take on board and to live by the immortal words of Michael Pollan from his great polemic ‘In Defense of Food – An Eater’s Manifesto’ :
“Eat food. Not too much. Mostly plants.”
Bevel, Malcolm Seth et al, Association of Food Deserts and Food Swamps With Obesity-Related Cancer Mortality in the US. JAMA Oncology. 2023;9(7):909-916. doi:10.1001/jamaoncol.2023.0634
Cullerton K, Donnet T, Lee A, Gallegos D. Using political science to progress public health nutrition: a systematic review. Public Health Nutr. 2016;19(11):2070-8. Available from: https://www.ncbi.nlm.nih.gov/ pubmed/26443533.
Ekwaru JP, Ohinmaa A, Loehr S, Setayeshgar S, Thanh NX, Veugelers PJ. The economic burden of inadequate consumption of vegetables and fruit in Canada. Public Health Nutr. 2017;20(3):515 23. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27819197.
Hyseni L, Atkinson M, Bromley H, Orton L, Lloyd-Williams F, McGill R, et al. The effects of policy actions to improve population dietary patterns and prevent diet-related non-communicable diseases: scoping review. Eur J Clin Nutr. 2017;71(6):694-711. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27901036.
National Collaborating Centre for Environmental Health 2017, 200-601 West Broadway, Vancouver, BC V5Z 4C2 www.ncceh.ca
Pagliai, G., Dinu, M., Madarena, M., Bonaccio, M., Iacoviello, L., & Sofi, F. (2021). Consumption of ultra-processed foods and health status: A systematic review and meta-analysis. British Journal of Nutrition, 125(3), 308-318. doi:10.1017/S0007114520002688
Tarasuk V, Mitchell A, Dachner N. Household food insecurity in Canada. Toronto, ON: University of Toronto; 2014. Available from: http://proof. utoronto.ca/resources/proof-annualreports/annual-report-2014/
Walsh, Bryan. “It’s Not Just Genetics.” Time. June 12, 2008. http://www.time.com/time/magazine/article/0,9171,1813984,00.html (3/05/11)
Yin Zhang & Edward L. Giovannucci (2022) Ultra-processed foods and health: a comprehensive review, Critical Reviews in Food Science and Nutrition, DOI: 10.1080/10408398.2022.2084359