Not only county-to-county. My friend did his PhD dissertation on how (at least in Rochester, NY), life expectancy varies by decades between zip codes. His research focused on urban Food Deserts and studied how the lack of access to healthy food nearby restricted diets to that available in convenience stores (chips, soda, etc). I wish I had access to his dissertation, but he just defended a month ago and cannot find it in any publications right now.
> His research focused on urban Food Deserts and studied how the lack of access to healthy food nearby restricted diets to that available in convenience stores (chips, soda, etc).
I hear this often but always wonder which way the causation arrow flows.
Do "food deserts" cause unhealthy eating? Or do groups of consumers that prefer unhealthy eating create "food deserts" with their purchasing decisions?
In the past 10 years or so, the notion that unhealthy eating and food deserts are related has been refuted in multiple articles and studies. Here are links to some of the more popular ones.
It does seem fairly obvious that it is lifestyle choice and like-minded cultural group bubbles as opposed to not having anything but garbage to eat nearby.
I'm not sure it has to be quite that binary. Certain areas of cities may be unattractive to better markets for a variety of reasons. However, I had the same thought you had. I'm not sure dropping a Whole Foods into an area with poor food options today is going to be a panacea that suddenly makes everyone eat healthy home-cooked meals. For example, this piece [1] presents a fairly mixed picture on whether new shopping options improve outcomes.
Whole Foods is absurdly expensive, though. Even after I became an engineer I didn't understand why I should pay like 3 bucks a pound for broccoli when I can get it for a buck a pound at the local Mexican/Chinese Shop (99 Ranch or ma and pa).
That's a better question: does dropping a cheap ethnic produce market into a neighbourhood that didn't have any cheap produce nearby before improve health outcomes?
Eating habits are cultural. People used to eating mostly cereal and bread throughout the day aren't suddenly going to start vegetables because vegetables drop in price and become more readily available and appealing for consumption. Humans are creatures of habit and social momentum.
What if in their neighborhood there are new restaurants with cheap, plant-based foods too? And if packaged food with refined sugars (cereals) and unhealthy oils got more expensive at the same time?
Humans can change their diets. It would help to be subsidizing healthy foods instead of refined sugars.
hey, I get all my organic ice cream and craft spirits from there.
You can buy junk food from almost any market, but WF is great because you can assume that everything they have is of reasonable quality, that their meat + fish is reasonably more sustainable / quality-controlled than elsewhere, that their produce is reasonably fresh, etc. It's more about saving time from not having to research every apple farm and figure out their distribution networks when I just want an apple. Also, their return policy is super generous ("I bought this brand and I actually don't like it" = money back), their lines move quickly (sometimes Safeway is a 30min wait), they're rarely sold out of things, and they have some higher-end products which are hard to find elsewhere (I like some fancy cheeses and cured meats). They have some of the same stuff at other places, sometimes for less money, but it's never more convenient or a one-stop-shop.
I've heard of a couple studies that say that the unhealthy eating is a result of consumers in the area not having either the time and/or the money to make better decisions. If you're working 2 jobs you may find yourself less able to make healthy decisions. In my more self-imposed case, I know that I wasn't able to eat healthy while pursuing an EE/physics degree while working an engineering internship. I was either sleeping or working and there was rarely time to prepare my own food or even go to the grocery store to get the ingredients.
This is not a scientific answer, but my perspective is that healthy food is more expensive, therefore purveyors of healthy food tend to avoid poor areas. It's not so much the consumer's "choice" to buy these products, but their inability to purchase or lack of knowledge that fresh foods may extend their lives.
Edit: Another issue affecting these consumers is that they may not have as much time to cook as a family with 2 parents working 1 job each.
Healthy food isn't very expensive if you're smart about it (it requires a bit of education and understanding nutrition). I live off of rice, beans, spinach, pita bread, whole grain pasta, peanut butter and the cheapest veggies I can find. I spend about 20$CAD a week on groceries.
Where's the steak? =) The day someone defines what "healthy food" actually is, or what subsets of food will suffice, will be the day people realize it can be had for as much or less than the unhealthy options.
Avoiding processed foods, limiting carb intake, and eating plenty of fruits and vegetables is a good rule of thumb. Also, make sure to stay hydrated to reduce false feelings of hunger.
When I was in college and couldnt afford steaks or other expensive forms of protein, I got them from eggs, one of the most well rounded sources of protein for the pricr
Yeah, but define "empty calorie". Like, I eat pretty low-carb (mostly because I feel better, not out of any ideological thing). Heavy on lean meats and green vegetables, while I avoid pastas, root vegetables, breads, etc.--I think a potato is the closest thing to an empty calorie you'll find this side of a sugar cube, but reasonable people can and do disagree.
Potatoes on their own aren't empty calories. [1] One medium potato is ~150 calories but full of potassium, vit c, and other nutrients. It's when you fry them or drench them in cheese and bacon bits and sour cream or mash them with loads of butter that they become unhealthful.
An empty calorie is one that provides little to no nutritional value other than the calorie itself. In my mind the most common empty calories come from sugars, some flours, and some oils.
Completely disagree: I eat a high-fat (~70% of calories from fat) and lots of protein diet (I'm about 12% bodyfat).
Bacon* and cheese and sour cream are the healthy parts of that meal, the potato is the "empty" thing by far, and the thing that will provide the highest glycemic load of those ingredients, spiking insulin.
(note that I have no idea what bacon bits are, or if they're even pork meat)
That's a fair cop. Potatoes are merely in the ballpark. (GI spikes for nutrients much more easily gotten from things that won't make me feel like crap? Either way, gimme.)
It's most likely a confluence of those, and other factors. My default inclination is to look to systemic effects first, though. So, in this case, whatever the specific balance between the confounding factors may be, my bet is that it's weighted towards "food deserts" creating the unhealthy habits, rather than being their consequence. People don't generally have a lot of choice but to eat what's available to them, and the overwhelming majority of what's available in these places is packaged and processed beyond recognition.
I grew up on the Great Plains, in the largest conurbation for hundreds of miles in any direction. I was literally surrounded by farm and ranchland. That area is classified as a food desert — a phenomenon I'm shockingly confronted with every time I fly home to visit the folks. Based on the conversations I've had with folks living there about this stuff, they (broadly) aren't even aware there are alternatives, or those alternatives are outright mocked. (Imagine growing up as a vegetarian when you have multiple relatives who ranch...)
I spend half of my time in a food desert and half my time in a hippie foodie mecca.
I think the answer is both. Rural areas lack the population to keep fresh food entrepreneurs from locating their businesses there.
At the same time, rural food culture tends to be shit outside of garden season - people think that potato chips and brownie mix are somehow valid ingredients in a recipe. They swap these "recipes" with their friends and look at you funny if you skip the bun and double up the veggies on your burger.
Well, based on his other activities helping lead an organization called Food Link (http://foodlinkny.org/), there is very high demand for healthful food in those areas. So while I would agree with you when taken without that context, he's been working hard for years towards proving the causation using multiple avenues.
And its not just causation. There are often unaccounted variables that are driving both the cause and effect and observing that decorrelates the cause and effect completely. There is some fascinating research going on on this in the field of economics. Matt Taddy, University of Chicago, Microsoft Research is doing some interesting research on this very kind of problem.
I also wonder about this. Most places restrict the number of liquor licenses, but I would imagine don't restrict the number of grocery stores. Large and small Asian markets seem to exist in a wide spectrum of neighborhoods.
Hm that is really interesting. I can definitely believe that effect.
I've bought groceries from the same few places for 7 years or more. It seems obvious that people buy food 90% of the time from the 5-10 places closest to them geographically. I live in a good area and they have good food.
But if my choices were all cheap soda and snacks like I see in other places, I imagine that would have a very concrete effect on my health. A few extra calories or a few more food adulterants every meal, every day, for 7 years or 20 years really adds up.
It seems extremely unlikely that there's no consequence of the food choices of your nearby grocery, so I'm glad that someone is measuring that effect.
The city I live in is supposedly a food desert but there are 6 grocery stores in the zip code that supposedly has none. They are huge chains like Kroger but they have everything you could imagine.
But even when I'm at Kroger or Meijer, people have carts full of frozen food, sugary drinks and snacks, etc. No fresh produce, no staples, etc.
I would imagine that it's not just convenience stores. I frequently ponder the fact that the grocery store closest to me is a marque of a US conglomerate (I live in Canada) that manages to have "low prices" by just treating Canadian stores as part of its US logistics chain—almost all of its products are shipped here from the US, rather than locally produced under US brands. And that includes things like baked goods and produce.
Thus, everything perishable in that store is either much "older" than you'd expect (i.e. it will go bad very soon after you buy it), or is pounded with preservatives—the bread, bagels, muffins, etc. all sort of have this uniquely-bad "springy yet doughy" texture: the sort of texture that I associate with Wonderbread.
Within the same distance there are local bakeries, produce markets, butcher shops, etc. that sell good stuff. But I don't doubt for a moment that certain families ignore those and go straight for the "everything shipped from far away" supermarket for all their shopping—and are having different health outcomes because of that.
>local bakeries, produce markets, butcher shops, etc.
That's probably where I would go to shop. Waiting for my local farm stand to open for the summer. And there's a nice local butcher down the road. But these are not cheap alternatives to my local grocery store (which actually has fairly decent produce, meat, bread from in-house bakery, etc.) I enjoy going to farmers' markets but they're not cheap places to buy food for the most part.
Fascinating, thanks for sharing. The points made in the article seem obvious, but doesn't offer much in terms of a suggested solution (conscientiously redraw zip codes). Do you know of any effort to have a more accurate "health boundary" region designation?
A major problem in any demographics research is data coding. For health-related demographics, HIPPA starts playing in.
Because mailing address is almost always provided in a healthcare setting, ZIP Code data are present in records. Similarly for coronor or death reports. Other alternatives, say, census block number, exist, but would have to be coded into the data. If you're already working with ZIP rollup data, you simply cannot recode for finer-grained analysis.
The most obvious data target would be the ZIP+4 encoding, though here in a provider context you'd likely run into HIPPA concerns (I've not worked in the field for some years). For death reports, that's obviated, so access to county death records at household detail would be an option, but you'd need to acquire data across all (or some sampling of) the 3,144 counties in the US.
Some of that data may be available in electronic form, but I'd suspect some level of fieldwork might still be required.
The optimal solution is likely a huge set of overlapping boundaries each accounting for different things.
Like if easy access to fresh groceries matters, the boundaries for that will not line up with the water system boundary (there could be some interesting correlations between the areas, but a good analysis would have to split out the boundaries to account for each effect).
I met someone working for the city of Oakland who was researching similar things here. She pointed out that life expectancy in the 'flats' of Oakland was 7 years lower than in the 'hills' of Oakland. That geographical boundary mostly separates the wealthy from the poor (though areas of the 'flats' are rapidly gentrifying). There are also other factors, such as proximity to pollution from highways and the ports, crime rates, etc.
>Not only county-to-county. My friend did his PhD dissertation on how (at least in Rochester, NY), life expectancy varies by decades between zip codes.
Amazing. Perhaps life expectancy even varies between households or...dare I say it...individual people?
EDIT: Not my friend's paper, but here is a similar study: https://hrs.isr.umich.edu/publications/biblio/8355