We see cycles of problems and solutions in our everyday lives. For example, when I’m happy, I play with my dog, Koschei, more and when I play with Koschei more, I become happier. This is an example of a reinforcing feedback loop – events or behaviors linked in a way to amplify or balance each other over time. Some cycles, such as those aptly named “balancing feedback loops,” balance out over time ]. When I’m hungry, I eat. After I eat, I’m not hungry, so I stop eating for a while. And so the cycle continues. We live in a world of balancing and reinforcing loops pulling us toward an equilibrium. Right now, we’re experiencing disruptions to our normal equilibrium with system-wide shifts brought on by COVID-19.
So, what does this have to do with food? Well, you may have heard of so-called food deserts, referring to areas without access to a full-service grocery store within a certain distance. Living in an area without a proximal grocery store has been linked to increased risk of diabetes, obesity and kidney disease.1-4 In Cleveland, Ohio, 60 percent of residents live in such areas.5 Given this information, it’s natural that researchers and policymakers turn towards increasing the availability of healthy foods as a solution for diet-related disparities. However, research has increasingly shown that these fixes do not have the sustained impact that we would like to see.6-8 This is not because increasing the availability of healthy foods is not important! On the contrary, it’s more important than ever.
However, people live complex lives in complex communities. Changing one aspect of someone’s environment isn’t necessarily enough to change the outcome. A few years ago, our Case Western Reserve University researchers realized this and, with the support of a FFAR Tipping Points grant, collaborated with two dozen local food system stakeholders to reconceptualize what the food system actually is. What contributes to food security, economic opportunity and fair access to fresh and healthy foods?
Over the past two years, we’ve been trying to answer these questions. We’ve formed dozens of models of our urban food system, called causal loop diagrams, developed through engagement with our team of residents in nearby communities, food business owners, food bank representatives, researchers and policymakers. Additionally, I worked with another researcher to collect individual interviews with residents, food retailers and policy and funding regulators to dive deeper into food system concepts. What we’ve learned from all this is that food systems are really complex!
As one interviewee put it, “What makes a healthy food system?…That’s kind of hard to even single out because it takes…because it’s so many other pieces.” Just as one thing alone does not make a system healthy, one solution alone cannot fully address inequities. We have now come to realize that several components are critical for a healthy food system to flourish, but we often don’t include these in our interventions. For example, job security is essential; if I don’t have a job, then I won’t have enough money to buy the food my family needs, my health will worsen and I’ll have a harder time finding another job. Another key variable is incarceration; in areas with high incarceration, individuals reentering society will face challenges in finding jobs, will rely more heavily on government assistance and will be less likely to achieve economic independence, which promotes fuller access to fresh and healthy foods.
Our next steps are to learn how we can translate our food system models into testable scenarios and to try out different food system interventions in our models to assess potential impact. I can’t say what we’ll find, but I can say that the best solutions will address multiple aspects of the problem, will be community-driven and community-engaged and may have wide-reaching impacts beyond the food system!
The FFAR Fellows program, through professional development training in skills mastery and interpersonal communications, is helping me learn how to reach a wide range of audiences with this work, including everyone from policymakers to researchers to local community members. I give many thanks to my advisor, Dr. Darcy Freedman, our project funders and to the FFAR Fellows Program for supporting my growth to become a leader in food systems research and practice.
- Dubowitz T, Zenk SN, Ghosh-Dastidar B, et al. Healthy food access for urban food desert residents: examination of the food environment, food purchasing practices, diet and BMI. Public Health Nutr. 2015;18(12):2220–2230. doi:10.1017/S1368980014002742
- Whitham D. Nutrition for the prevention and treatment of chronic kidney disease in diabetes. Can J Diabetes. 2014 Oct;38(5):344-8.
- Shagdarsuren T, Nakamura K, McCay L. Association between perceived neighborhood environment and health of middle-aged women living in rapidly changing urban Mongolia. Environ Health Prev Med. 2017 May 31;22(1):50.
- Garfinkel-Castro A, Kim K, Hamidi S, Ewing R. Obesity and the built environment at different urban scales: examining the literature. Nutr Rev. 2017 Jan;75(suppl 1):51-61.
- Cuyahoga County Board of Health. Cuyahoga County Supermarket Assessment: 2018 Inventory Update. March 8, 2019.
- Freedman DA, Bell BA, Clark J, et al. Small Improvements in an Urban Food Environment Resulted in No Changes in Diet Among Residents [published online ahead of print, 2020 Mar 13].
- Cummins S, Flint E, Matthews SA. New neighborhood grocery store increased awareness of food access but did not alter dietary habits or obesity. Health Aff (Millwood). 2014;33(2):283–91.
- Elbel B, Moran A, Dixon LB, Kiszko K, Cantor J, Abrams C, et al. Assessment of a government-subsidized supermarket in a high-need area on household food availability and children’s dietary intakes. Public Health Nutr. 2015:1–10.