Eat Healthful Food...If You Can Find It

For those who embrace the wellness movement, two federal departments have just issued two separate reports that hearten and frustrate for the same reason.

First, the Department of Agriculture issued a report on Wednesday that found that healthful foods such as fresh vegetables cost no more "per calorie" than processed foods and junk foods. That bit of economic analysis eliminates a lame excuse that many of us have used while waiting in the $1 menu line at McDonald's.

One day after this report was released, however, the Treasury Department issued a report that found that 24.8 million Americans live in areas with limited supermarket access, what the feds call LSA, a problem significant enough to warrant its own acronym.

The Treasury report, Searching for Markets "identifies 1,519 communities where supermarkets do not exist, and where the unmet demand within the community is large enough to support a full-service grocery store." Treasury says LSA communities are 2.28 times more likely to be low-income and have larger minority populations.

These reports underscore a stubborn hurdle that faces well-meaning wellness advocates. While it is heartening to know that fresh foods are just as affordable as junk food, that information is teasingly useless for 25 million generally poorer Americans who could greatly benefit from healthier diets but have limited access.

And these two reports should give pause to advocates of "skin-in-the game" punitive financial measures such as higher health insurance premiums for overweight or obese people. It's not that simple.

Let's be clear: Lack of access to fresh produce does not give anyone license to simply forfeit responsibility to maintain his or her health. It is imperative that we find the incentives that make people adopt healthier lifestyles. However, it is also unfair to hold everyone to the same weight measure or dietary standard when it is not so readily available to all.

It is legitimate to say that if a person doesn't take the initiative for his own health, nobody else will. Action is needed, but it shouldn't be a one-size-fits-all strategy that penalizes the people who can least afford it.   

Businesses establishing a wellness program should take the time to tour neighborhoods where their lower-wage employees live to better understand the advantages and challenges they may face in their home environments.

It's not just about access to healthy food. We can advocate fitness measures and exercise programs, but does that take into account neighborhoods with no sidewalks or parks, or inadequate street lighting, or higher crime rates? Does the supervisor who devises an exercise plan while sitting at a desk all day understand that some workers might be standing on their feet for eight hours a day or longer and are therefore less enthusiastic about that after-work Zumba class?

For safety net healthcare providers that see firsthand the debilitating effects of the overweight and obesity epidemic, the problem is even larger than an employee wellness plan. How can we hope to improve health outcomes if patients who live in LSAs are sent home with a simple admonishment to eat more greens?

It is not enough to restate to people the obvious fact that they need to eat healthier diets. Even armed with that knowledge, no person can follow that directive if they can't regularly and easily access the healthier food.

In April I spoke with Chip Johnson, the mayor of Hernando, MS, a city that was recently identified as one of the healthiest in the Magnolia State. Johnson is one of those innovative types who understands that a problem as big as the obesity epidemic can't be solved with one sweeping mandate.

Instead, Hernando has taken a long-term incremental approach towards improving the health of its residents with simple steps that include building more sidewalks and bike lanes, and improving access to healthier food. The city situated its farmers' market within walking distance of its poorest neighborhoods.

"We can't expect people to eat healthier and be healthier if they don't have access to those foods. So a farmers' market is one way to do that," Johnson told me. "And you have to make sure your farmers' market is in places that are within reach of your poorest communities, your underserved communities." 

This is a good first step for healthcare organizations and community wellness advocates who find that they may have an LSA in their service area.

It is time to promote not just eating healthier food but access to healthier food.