NC1196: Food systems, health, and well-being: understanding complex relationships and dynamics of change
(Multistate Research Project)
Need and Importance
While the importance of food to health and well-being is clear, the specific ways in which food systems contribute to individual and community health are not well understood. This is a complex issue, which requires improving food systems as well as changing mindsets and behaviors of individuals within the food system.
Nearly 14.3 percent (17.5 million) of U.S. households were food insecure at some time during 2013. Both children and adults were food insecure in 9.9 percent of households with children (3.8 million households). Although children are usually protected from substantial reductions in food intake even in households with very low food security, nevertheless, in about 0.9 percent of households with children (360,000 households), one or more child also experienced reduced food intake and disrupted eating patterns at some time during the year (USDA ERS, 2013).
According to USDA ERS (2013), the prevalence of very low food security in various types of households followed a pattern similar to that observed for food insecurity overall. Very low food security was more prevalent than the national average (5.6 percent) for the following groups:
Households with children headed by a single woman (10.8 percent),
Women living alone (7.4 percent) and men living alone (7.6 percent),
Black, non-Hispanic households (10.1 percent),
Hispanic households (6.7 percent),
Households with incomes below 185 percent of the poverty line (14.4 percent),
Households located in principal cities of metropolitan areas (6.3 percent), and
Households located in the South (6.2 percent).
In addition, the connection between obesity and food insecurity is increasing in the US. Studies indicate that one in three food insecure adults were obese. Food insecurity was associated with obesity in the overall population and most population subgroups (Pan et al., 2012)
Many of the food-related health problems in the US disproportionately affect children, women, ethnic minorities, and low-income people. Addressing these problems requires that we understand more about the processes of institutional change, structural conditions, perceptions, and decision-making. The environment itself determines much of what individuals can draw from it. Community norms may dictate who has access to food assistance; civically engaged communities for example provide more food assistance and make food resources for the poor more easily accessible. Furthermore, consumer and producer attitudes and interests may conflict over some issues surrounding sustainability and health (Selfa et al., 2008).
One line of research that has emphasized an environmental or structural approach to food systems draws on the notion of food deserts, a term that has gained widespread use and conceptual salience in the U.S. (see Beaulac and Cummins 2009). Food deserts are: “populated urban areas where residents do not have access to an affordable and healthy diet” (Cummins and Macintyre 2002:436); “areas characterized by poor access to healthy and affordable food (Beaulac and Cummins 2009:A105); and “areas with little or no provision of fresh produce and other health food” (Bader et al. 2010). Individuals residing in food deserts generally are economically disadvantaged, have poor nutrition as they are generally consuming cheaper and more filling foods, and are geographically disadvantaged in terms of the number of full service food stores in their general area of residence (Guy and David 2004). A recent review of food desert research supports the general conclusion that “Americans living in low-income and minority areas tend to have poor access to healthy food” (Beaulac and Cummins 2009:A109).
Focusing on the effect of socioeconomic differences and health outcomes, Pampel et al. (2010: 360) argue that in the U.S. and Canada there is an association between “obesity and food quality, prices, and availability in a community.” Augmenting these findings that report stratified patterns of diet-related poor health outcomes, (e.g. obesity, diabetes, hypertension) is a copious body of health and nutrition research (see for example Nestle et al. 1998; Cummins and Macintyre 2006; Moore and Diez-Roux 2006; Flora and Gillespie 2009; Schafft et al. 2009). Morland and Filomena (2007) and Franco et al. (2008) report in the American Journal of Preventative Medicine and Public Health Nutrition that access to full service retail food outlets offering fresh and frozen produce is better in predominantly white and higher income neighborhoods than in black, mixed race, and lower income neighborhoods. Within the relatively few supermarkets and grocery stores found in black, mixed race, and lower income neighborhoods, the amount and variety of healthy foods was found to be significantly lower than in supermarkets and grocery stores in predominately white and higher income neighborhoods located in large cities (Morland and Filomena 2007; Franco et al. 2008). The above work has led to a need for more research and applied efforts towards resolving these problems of availability and access.
Advantage of a Food Systems Approach
A systems approach to food in local communities and families, one that takes into account the social, economic and cultural aspects of food, is required to unravel the mysteries of food-related problems in multiple dimensions. New and community-engaged approaches to the conceptualization, study, and outreach and their integration are needed to address constraints to health and well-being including obesity, food insecurity, diabetes and other chronic diseases.
The purpose of this project is to investigate these complex relationships, involving key stakeholders in analyzing and addressing problems and solutions. Our goal is to increase understanding of food and nutrition practices and systems, and to facilitate food-related institutional, community, family, and individual behavioral changes that can improve health and well-being and enhance learning and changes across regions and sectors of the food system.
This project will examine family, community, and institutional dynamics to better understand how the food system influences individual and population health and well-being. We will engage with the underserved as well as community stakeholders and decision makers through Collaborative Engaged Research Methodology (Gillespie, 2010), and explore other means for creating sustainable community access to food. While university-based research, education, and outreach programs have not always served or been accountable to people of color and underserved populations (Slocum, 2006), in this project we will develop an inclusive, community-oriented, participatory approach. This will require a focused effort to work with groups that have historically had less ability to access and benefit from university programs than have traditional agricultural clients.
A food systems approach to food security requires that we understand food insecurity as potentially arising from problems at any node of the food system, including food availability, stability of supplies across seasons, sufficient resources to access supplies, and consumption and utilization factors. For example, food systems involve wholesale and retail sources of food within reach of communities under study. Using secondary data such as the USDA Food Atlas, much can be learned about the number and type of sources of food. The next step is to go on line to determine more specifically the location of these food outlets relative to low income areas in a community. Samples of these outlets can be drawn, determining the healthiness of the products being sold and their prices. Finally, a sample of low income neighborhood dwellers can be drawn in order to determine the opportunities and barriers to affordable, healthy food can be ascertained. One area of constraint that food preparers in households experience is a lack of skills in planning meals, shopping with those meals in mind, and cooking the foods needed to create particular meals.
The 1196 research team is skilled and experienced in a variety of research methods ranging from complex dietary recalls and nutritional security analysis to photo-voice and GIS work. Their work has been published in peer-reviewed scientific journals, Extension publications, and books from respected university presses and other publishers. As members of research-intensive universities, this group has access to the most recent data, software, and computing resources necessary to carry out the research. The team has extensive experience in working at multiple levels and with a range of stakeholders to integrate research with education and outreach.
The Advantage of a Multistate Approach: NC-1196 Group Expertise and Strengths
Our interdisciplinary research team is well positioned for this multi-state effort of conceptual and empirical engagement with the complex issues of food systems, health, and well-being. The team has extensive experience in working at multiple levels and with a range of stakeholders to integrate research with education and outreach. Since our project group is composed of members from states in many areas of the country, we will be able to learn from and engage with people with different historical experiences and contemporary conditions. This diversity and range will greatly increase the scope of action, and the knowledge base for future work. Moreover, multiple disciplines (including economics, nutrition, sociology, anthropology, and geography) are represented on the project team, ensuring that problems and solutions will be addressed from a range of perspectives and methodologies.
The NC-1196 has evolved over the past ten years to a diverse mix of regional, disciplinary, and methodological approaches. Our team brings the following benefits to this project:
1. Interdisciplinary perspectives – The NC-1196 group includes individuals with diverse disciplinary backgrounds, including nutrition education, rural sociology, youth development, nutrition anthropology, food science, nutrition science and dietetics. This mix provides cross-disciplinary training in the biological, physical, and social sciences. It also leads to the establishment of interdisciplinary teams of researchers on grant applications and projects sponsored by the multistate group. In the context of the project proposal, an interdisciplinary group like ours has the ability to approach the range of material and non-material dimensions of food systems.
2. Mixed methods – The NC-1196 group includes individuals using a variety of quantitative and qualitative methodologies. As mixed methods are currently favored in many research areas (particularly in the social sciences), having NC-1196 group members with broad expertise provides both a learning context for all members as well as the ability to combine methodologies on single projects and activities. For example, our team members’ workshop on evaluation conducted by staff from the National Science Foundation (to be held in October 2015) will emphasize the latest mixed methodologies as they apply to project and program evaluation. Members of the 1196 group are variously skilled at methods ranging from complex dietary recalls and nutritional security analysis to photo-voice and GIS work.
3. Integrated projects – The NC-1196 group includes land-grant university faculty with a variety of types of positions, from full-time research and teaching faculty to full-time Extension faculty. We also have faculty with broad experience in publishing, organizing public events, outreach education, and grant-writing. These combinations allow us to discuss and undertake projects and group activities that fully integrate research and outreach education, and often involve campus academic programs as well. We are also able to synthesize a diversity of end products into our activities; over the five-year course of our current project, we have hosted symposia, engaged in dialogue with program officers from NIH and USDA, held workshops on evaluation, conducted field tours, and cooperated on several grant applications.
4. Regional and population diversity – The NC-1196 group truly represents geographic diversity (from Hawaii to Maryland and from Texas to Minnesota) and the range of stakeholder groups that allow us to look at applied research and interventions across population and demographic subgroups. Local food systems vary significantly as do food-related skills; some of these differences many vary significantly by region and state. The advantage of this regional project is that its members represent nearly a dozen states in the mid-West, South, and East Coast. Individual studies across these states are both technically feasible and relatively low in cost.
We have members who deal with, among other groups, Native American populations, the homeless, veterans, children, pregnant women, seniors, food pantry participants. As we seek to generalize from members’ research and experiences, it is helpful to have these diverse audiences in mind to remind us of the various social and cultural variables influencing individual and group behavior. In this way, our diversity acts as a sort of “checks-and-balances” as we seek to generalize our findings from the local to the regional to the national.
Just as the multistate group’s approach is holistic and systems-based, so to do we aim our impacts at diverse nodes of food systems. Much of our research is consumer-oriented, focusing on issues of decision-making regarding consumption, food purchases and nutrition. Projects in the schools target children’s meals and snacks, while SNAP-education and WIC-education projects focus on stretching limited food access resources and using available resources to address specific nutrition-related health vulnerabilities. Our studies have found, for example, that low income shoppers can benefit from training in order to make meal planning and shopping planning more effective within the food system in which they are a part. Sharing the results of the study of food preparers and suggestions about how consumer needs might be better served can be shared with retailers as well as other providers of food.
In any of these cases, however, we recognize that consumer choices are often constrained and influenced by the contexts and structures (and systems) in which they live. For example, school meals are impacted by, among other things, USDA regulations, local school boards, access to alternative food sources, and teachers. Thus our work includes having impacts on the agents within any food system whose decision-making influences the options available to any group of consumers, be they children in schools or adult shoppers.
We also aim to impact food production and distribution systems. Some of us work with farmers’ markets, community gardens, and other sources of production, and especially the kinds of local production systems that impact community food security. Our researchers work to improve the quantity and quality of farm-to-school programs as well as self-provisioning activities within limited-resource populations. In a related vein, we are also interest in the acquisition and distribution of food through various types of retail markets as well as the emergency food system. The former lends itself to analysis of the “food environment” in terms of availability, cost, and access. The latter is especially focused on the (so-called) temporary emergency food assistance programs, particularly the private system comprised largely of food banks, food pantries, and food sites (e.g., soup kitchens, emergency shelters). Through conducting research in these contexts, we assist organizations in understanding their clientele, help in improving the quality of the food distributed through these systems, and work on outreach education in the contexts in which consumers interact with providers.
Finally, members of this project aim to impact policy-makers and the various public and private policies that influence the structure and content of our food systems. Through the preparation of public products (e.g., policy briefs, hunger maps and atlases, publications for the popular press) we engage in a type of translational activity to make our research and results available to wider segments of the public. Given the range of public and private institutions involved with our food system and concerned about the health consequences of diets, working at both structural and individuals levels promises to have the most widespread impacts.