The United States has an obesity epidemic, and although it would be easy to place blame on individual decision making, many Americans don’t have access to fruits, vegetables and other healthy food at a price they can afford. The Centers for Disease Control and Prevention (CDC) has a name for areas in which people live far from a supermarket or large grocery store that sells nutritious foods and where much of the population lacks easy access to transportation: food deserts.
Much of the rural area around McAllen, Texas, could be considered a food desert, as there are few public bus routes, leaving those without their own vehicle to rely on friends or family members to get to grocery stores.
“In Hidalgo County, which contains McAllen, 46 percent of the population lives in census tracts designated as food deserts,” said Ms. Evelia C. Castillo, program coordinator of the CDC-funded Hidalgo program Working on Wellness (WOW). Ms. Castillo, who works from the Texas A&M University Health Science Center’s McAllen campus, said “Through the WOW program, we are working through community-based coalitions to improve healthy food access in Hidalgo County.”
Dr. Monica Campos-Bowers, instructional assistant professor at the McAllen campus of the Texas A&M School of Public Health and an evaluator for WOW-Hidalgo, sees the problem as largely one of access — the population’s access to fresh and healthy food, public health practitioners’ access to the population, and farmers’ access to people who can and will buy their food at fair prices.
“WOW-Hidalgo aims to decrease obesity in our region, and one way is to address food retail opportunities — to get people access to any fruits or vegetables,” Dr. Campos-Bowers said. However, that’s not as easy of a proposition as it sounds. “You think that if you just plop a farmer’s market in the middle of a food desert, everything will be solved, but that’s not how it works. The population might not even want the farmer’s market.
“Community ownership in the initial assessment, implementation and monitoring of such a program is vital for sustainability and long-term success,” Dr. Campos-Bowers added.
Although the area is generally warm with two growing seasons each year, making fresh, locally grown ingredients available nearly year-round, some farmers aren’t producing because it’s not profitable.
“For some farmers, selling their produce isn’t paying for their costs,” Dr. Campos-Bowers said. “How do you make it valuable for the farmers to come to food deserts and sell their produce?”
As part of Texas A&M Healthy South Texas — an innovative public health extension platform that combines the clinical expertise of the Health Science Center with AgriLife Extension Service’s statewide reach — WOW-Hidalgo and other initiatives have been empowering the community to implement innovative solutions. For example, they plan to work with local community clinics to stock local produce that the providers can prescribe to high-risk patients as they would a medication.
“This way, we can support local farms and help patients at the same time,” Dr. Campos-Bowers said. “If they’re seeing which foods are good for their diabetes, for example, and what they should be eating, that might help them know what they should buy next time to help their condition.”
“We want to show that you can get healing through your food,” Dr. Campos-Bowers added.
Another program utilizes existing social welfare resources to give people options about the fresh fruits and vegetables they consume. Families enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the area get a voucher for a fixed amount to spend at the local farmer’s market. Such initiatives also serve the dual purposes of supporting farmers and getting their products to the population.
Getting gardens into elementary schools is also an important part of teaching healthy habits.
“Summer programs and schools are a huge asset with regards to access to these populations,” Dr. Campos-Bowers said.
There is also a role for public policy in the solution. “If cities or communities pass laws that 20 percent of the shelves in grocery or convenience stores have to be fresh fruits and vegetables, that really helps with access,” Dr. Campos-Bowers said. The pricing of items, whether through tax incentives (or disincentives for junk food) may also be important.
Still, any intervention should consider the particular community. In South Texas, where much of the population is Latino or Hispanic, anyone creating the interventions should understand the cultural dynamics.
“It’s vital to remember that any intervention must be culturally sensitive,” Dr. Campos-Bowers said. “Instead of telling people to stop eating foods they are familiar with and that they enjoy, perhaps suggest and provide a small change to a healthier alternative.”
Some research has shown that available resources, culture, education and food preferences may be more important for determining a healthy diet than simple access might be. Therefore, WOW is also including education and demonstration in their interventions.
“We found that access is only one part of the puzzle, as some of the produce at the farmer’s markets are not consumed regularly by residents in our area,” Dr. Castillo said. “We have started to deliver food demos to educate participants on how to incorporate vegetables and fruits into their diets as well.”
“We don’t know what’s going to happen or what programs will work, but one thing I see as valuable is that they’re trying,” Dr. Campos-Bowers added. “We can learn from both successes and failures.”