Earlier research suggesting that better fresh-food access improves diet and would therefore improve the health of people living in poverty was drawn from small samples or looked at store availability in narrow geographical slices—often without information about how or where the people who lived there shopped. “They never link the neighborhood characteristics to actual individuals,” explains Helen Lee, author of the Social Science and Medicine study. “Without that, all you have is speculation.”
Lee also notes in her study that, on closer inspection, food deserts don’t actually exist in the U.S., at least not as a national problem—on average, poor neighborhoods have more grocery stores than wealthier neighborhoods. Even before Obama’s Healthy Food Financing Initiative was announced in 2010, studies suggested that the food desert explanation for obesity wasn’t right. A report from Department of Agriculture researchers presented to Congress in 2009 also showed more grocery stores in poor neighborhoods. In 2012, USDA researchers crunched the data again and found once more that low-income neighborhoods had more—not fewer—grocery stores.
Why, then, do campaigns like the Healthy Food Financing Initiative persist? The push for fresh food is usually considered a progressive cause, connected as it is to criticisms of processed foods’ effect on health. And the most prominent voices against the fresh-food push have been conservative, from Rush Limbaugh to Reason magazine. But look a little closer, and fresh-food financing initiatives are a pretty conservative idea. They offer a market-based opportunity for individuals to make better choices about health, leaving the impression that people living in poverty get sick for reasons that are within their control.
In fact, researchers who focus on health disparities have suspected for decades that people who live in poverty die early because of the stress of poverty itself rather than the poor health choices low-income people make. That’s not to say that poor people don’t make decisions about diet and exercise, but in general they are preoccupied with very different choices than wealthier people are: Should I pay my electricity or my water bill? Can I pay my rent and buy my kid a pair of school shoes? The immediacy of these pressures may make it more difficult to think about how eating choices today will affect health 10 or 20 years from now.
But more importantly, the constant calculus of survival will wear down mind and body and deteriorate health over years. Bruce McEwan, one of the pioneers of research in the biology of health inequality, coined the term “allostatic load” to describe the cumulative wear and tear of stress reactions over time. Stress reactions, like floods of adrenaline and cortisol and increased blood pressure, are helpful as short-term reactions to dangerous or challenging situations. But if stress reactions are constant, they create physiological conditions that damage the body. “One of the things having an elevated sympathetic response is that you have an inflammatory tone in the body,” McEwan explains. “Inflammation underlies all of the diseases of modern life—from cancer to depression to neurological diseases.” Those diseases of modern life also include heart disease, hypertension, and diabetes—illnesses we typically associate with poverty.
But the implication of McEwan’s research—that poverty itself is making people ill—is not one that Americans are prepared to accept. Instead, we build supermarkets, finance green grocer carts, and teach former inmates about fennel, feeling like we’re promoting a progressive effort to improve the plight of the disadvantaged. Meanwhile, poor people are living shorter, sicker lives, with no helpful new policy in sight.