By Raekwon Williams
The Stories to Save Lives Project uses oral history methodology to document the health, illness, and medical care in many counties across North Carolina as a part of the Southern Oral History Project. The interviews from the database help to contextualize the perspectives of different social, racial, and ethnic groups on health and the health care system. The social and community context impacts the resident’s access to adequate food to lead a balanced lifestyle. Three of the interviews in the database help to contextualize the experience of residents living in Nash and Edgecombe County particularly pertaining to food insecurity.
The five main areas of social and economic determinants of health are economic stability, education, social and community context, health and health care, and neighborhood and built environment (Center for Disease Control and Prevention). Health disparities and inequalities are a result of policies, programs, institutions, and other social and economic factors that disproportionality impact specific groups (Secretary’s Advisory Committee on National Health Promotion and Disease Prevention). The lack of money and resources in communities in North Carolina contributes to the limited access to healthy foods needed to support a balanced diet (food insecurity). The food insecurity rate in Edgecombe County is 25.3% but only 18.8% in Nash County according to Feeding America, a nationwide network of food banks and programs fighting hunger in communities. The differences in social and community context in these neighboring counties are evident in the stark differences in rates of food insecurity and health outcomes.
Wilma Void, a resident of Nash County, talks about the differences in prices of food compared to a neighboring county, Edgecombe County. Void explains that:
“Even the stores, like the stores are different. I have a friend that lives on the Edgecombe side. She said the Food Lion on their side is different from the Food Lion on this side… Like we’ll have, on this side, we’ll have the water, the purified water at Food Lion for $1.99 for 24, and on their side it’s like $2.49… “I can’t afford to pay that extra,” what, 50 or 60 cents. “And if I buy two, that’s an extra dollar.” (1:34.21-1:35:10)
Although a $0.50 difference in the price of water may not seem significant, this difference in price may extend beyond just water to other food options in the food stores. The inflation of food prices in Edgecombe County impacts its residents’ access to healthy foods, leading to higher rates of food insecurity. The needs in both counties were assessed from collected from surveys of residents and local health databases and constructed into a comprehensive Community Health Needs Assessment. The stark differences between the two counties led me to consult the Community Health Needs Assessments to better understand the lifestyle differences that residents battling food insecurity faced. These assessments compiled data of trends in health needs in Edgecombe and Nash County. The assessment of Nash County helped to contextualize the experience of residents, like Wilma Void, living in a community with high rates of food insecurity.
Socioeconomic status is a strong determinant of health mainly measured by income, education, and occupational status. The 2019 community health needs assessments revealed that the median income in Edgecombe County is about $43,804 (Nash County: 2019 Community Health Needs Assessment) while the median income is about $32,298 (Edgecombe County: 2019 Community Health Needs Assessment). This gap in median income shows the wealth inequities between the counties as all its residents don’t have access to the same resources ultimately leading to an increase in the rates of food insecurity. The unequal distribution of resources limits accesses to foods to maintain healthy lifestyle choices. Thus, leading to higher rates of food insecurity. The health needs assessments revealed that chronic diseases like heart disease and stroke were prevalent in these communities, which can be linked to increased risk due to the high rates of food insecurity. The impacts of food insecurity on children are commonly assessed due to the increased risk of long-term health problems. Food insecurity has been associated with increased risks of birth defects, depression, hospitalization, and behavior problems (Gundersen and Zilak).
Income is often associated with food insecurity although overlapping factors like affordable housing, location, and chronic health issues can impact access to healthy food choices. The factors that contribute to poor lifestyles choice are not always influenced solely by individual decisions but are rather influenced by structural reasons. Patients are often blamed for unhealthy food choices with doctors telling them to just make healthier choices. These types of medical care plans advise changes in nutritional choices while lacking structural programs for patients to access healthier meals since they are often live in food deserts. Nathaniel Moses explains a structural program that addressed food insecurity in Edgecombe County:
“Also… health within school.. I did see a couple years ago when Michelle Obama with her healthy initiatives for schools, and schools started giving fresh fruit and the lunches, you know, the pizza with wheat bread and hotdog buns and rolls were wheat bread, and it’s amazing how the shift can occur, because at first the kids hated it, but eventually it was the norm. So, I thought that was amazing too.” (35:17-35:45)
Crystal DeShazor talks about how lack of knowledge is another hurdle to having a healthy community since sometimes unhealthy foods are promoted since they are the only options available.
“I think just knowledge, I think, because it’s like when you have been—this is all you know, all you know is bologna sandwich, you know what I’m saying? All you know is bologna sandwich, all you know is soda, because when I go down the street to the store, that’s what I’m going to pick up, that’s all you know, and nobody has said, “That’s not good for you.” It tastes good and we promote it a lot, like fried chicken. Just different things. Nobody ever says, you know, “We shouldn’t eat that.” Nobody never says that.” (41:31-42:04)
Food insecurity in both Nash and Edgecombe county results from the unequal distribution of wealth and resources, the lack of structural food programs, and the lack of food options. Void highlights the inflation in prices in markets that limit access to these products especially those with a lower socioeconomic status. Moses and DeShazor highlight that there are structural barriers that influence poor lifestyle habits resulting in poorer outcomes. The prevalence of heart disease and stroke in Nash and Edgecombe County is caused by these counties’ social and community context.
Center for Disease Control and Prevention. About Social Determinants of Health (SDOH). 10 Mar. 2021, https://www.cdc.gov/socialdeterminants/about.html.
Edgecombe County: 2019 Community Health Needs Assessment. Health ENC & Conduent HCl, 2019, p. 190, https://www.vidanthealth.com/wp-content/uploads/2020/11/2019-Edgecombe-County-CHNA_FINAL.pdf.
Gundersen, Craig, and James P. Zilak. Food Insecurity And Health Outcomes. no. 10, Nov. 2015, https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.0645.
Interview with Crystal DeShazor, 22 October 2018, Y-0087, in the Southern Oral History Program Collection #4007, Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Interview with Nathaniel Moses, 25 June 2019, Y-0116, in the Southern Oral History Program Collection #4007, Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Interview with Wilma Void, 07 June 2019, Y-0135, in the Southern Oral History Program Collection #4007, Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Nash County: 2019 Community Health Needs Assessment. Health ENC & Conduent HCl, p. 199, https://nashcountync.gov/DocumentCenter/View/5416/2019-Community-Health-Assessment.
Secretary’s Advisory Committee on National Health Promotion and Disease Prevention. Healthy People 2020: An Opportunity to Address Societal Determinants of Health. 26 July 2010, pp. 1–16, https://www.healthypeople.gov/sites/default/files/SocietalDeterminantsHealth.pdf.