Introduction

Food deserts are residential areas classified as having poor access to healthy and nutritious food. The existence and establishment of food deserts in the United States correlates with race and socioeconomic status, resulting in health outcome disparities across different racial and class identities [1]. The term ‘food swamp’ is used to describe areas that are not only lacking in affordable healthy options, but are abundant in unhealthy fast foods, and they are considered both a separate and more significant phenomenon when it comes to informing health [2].

Food deserts and swamps are terms that describe a much larger system of food apartheid, which refers to the segregation of food resources that reflect structural societal injustices. This term emphasizes systemic racism embedded in policies that perpetuate inadequate food access while underscoring the large role that race, class, and geography play in determining inequity and access [3].

In multiple Southern Oral History interviews, interviewees discuss difficulties accessing grocery stores with reasonably priced produce in North Carolina, and they describe the food landscape within their communities as being inundated with cheap fast food options. Their experiences help to demonstrate the significant role that food insecurity and inadequate access to healthy foods play in determining the health outcomes on individual and community levels as well as the strong influence that a community’s food environment has on people’s ability to live a healthy lifestyle. 

Understanding both healthy and unhealthy sources of food is important when considering the broader concept of healthy behaviors. Food deserts and swamps are a form of geographic barriers, and they serve as a part of a larger network of structural barriers to health that significantly and disproportionately impact rural and low income areas. 

Far Distances from Healthy Foods

One characteristic of food deserts associated with negative health outcomes is the lack of nearby grocery stores that provide access to affordable, healthy options. When asked about the markets in Warrenton, NC, Jennie Franklin says, “There is no market in Warrenton. This is a food desert. That’s the only way to put it [4].” She then says she has to drive approximately forty five minutes to Rocky Mount to get to the nearest Aldi or wait until she passes through Durham to go to Costco, which is an hour from Warrenton. Jennie says that Aldi has reasonably priced produce, and that she only goes about once a month. 

“There is no market in Warrenton. This is a food desert. That’s the only way to put it (Franklin 1:40:35.1).”

While Jennie and her family are able to make the long commute in search of affordable produce, many lower income families cannot. Carla Norwood, when asked about healthcare in relation to wellness in Warrenton, says that “[people] need access to food that is actually good for them…A lot of people may have trouble getting to a grocery store, but if you can get to a grocery store, that’s not a problem [5].” She believes that if people are only able to get to grocery stores, eating healthy becomes easy. Carla also expresses a desire to see readymade, affordable meals closer to home, but she claims that is impossible in her town.

Both Carla’s and Jennie’s testimonies demonstrate the struggle of eating healthy when there is an extreme lack of grocery stores closer to home. For individuals lacking the means to travel to surrounding towns to shop—such as transportation, time, or money—limitations in nearby healthy food options can greatly restrict their ability to make positive dietary choices.

Accessible Unhealthy Food Options 

Another such issue related to food swamps is the overabundance of unhealthy food options. Nell Burwell, a resident of Edgecombe County, North Carolina, expressed concerns over her community’s health, saying Edgecombe County has very high rates of diet related disease. Nell elaborates, saying, “What do we have on this side of town that has healthy food? Only thing we have, we have fried food. We have Kentucky Fried Chicken, Bojangles’, McDonald’s, Hardee’s, Gardner’s, as far as right in this area…We don’t have anywhere like a farmers’ market where we can go buy vegetables and things like that [6].” While Nell mentions a lack of healthy grocery stores in her area, she primarily focuses on the copious amounts of fast food. Her description of Edgecombe County as a food swamp followed by her discussion of disease emphasize the significant detrimental impact that an oversupply of unhealthy foods has on health.

“What do we have on this side of town that has healthy food? Only thing we have, we have fried food. We have Kentucky Fried Chicken, Bojangles’, McDonald’s, Hardee’s, Gardner’s, as far as right in this area…We don’t have anywhere like a farmers’ market where we can go buy vegetables and things like that (Burwell 0:53:01.1).”

Patricia Somerville, of Warrenton, North Carolina, brings up another issue with the mention of food banks, organizations dedicated to distributing food to needy individuals. She, however, highlights issues with the Warrenton Food Banks, saying, “oh, gosh, I went there and I stopped going because all I was getting was canned diet sodas, a whole bunch of candy and mess, some string beans, and something else [7].” Patricia believes that families should be able to access healthy foods, but that expensive produce prices at the limited grocery stores make eating healthy unsustainable for many. If options designed for lower income families and individuals further contribute to the overconsumption of unhealthy foods, already disadvantaged populations are put at further risk for diet-related diseases and worse overall health.

Negative Health Outcomes Associated with Lowered Access to Healthy Foods

The impact of limited healthy food options in conjunction with an overabundance of fast food restaurants on health outcomes are profound. Andrea Williams-Morales, a health care professional from Dunn, NC, describes her community as one facing “a lot of issues with diabetes, with cholesterol, with obesity. I know we have—I think diabetes is probably one of our biggest issues that we have concerns, health concerns [8].” Andrea also attributes many of these issues to a lack of access to affordable produce and healthy foods. As a healthcare provider, Andrea can observe firsthand the impact that a lack of healthy foods has on her community, and it is the medical system that must ultimately bear the responsibility of addressing illness caused by a larger system of food apartheid.

In multiple studies across various parts of the country, researchers have found that living in food deserts is associated with worse pediatric cystic fibrosis outcomes [9], an increased likelihood of spontaneous preterm delivery [10] and lower metabolic health during pregnancy [11], and a higher risk of adverse cardiovascular events [12]. In their study of cardiovascular disease risks, the authors also note that the correlation between food deserts and risk may be more tied to income level than food access [12]. This is still significant, as race, socioeconomic status, and income level are intertwined in a complex matrix that often disadvantages Black and other minority communities. In Forsyth County, NC, it is the poor (and Black) neighborhoods that are, on average, much further from supermarkets with fresh seafood and produce than more affluent, white areas [13]. These residents are also less likely to own their own cars, and as such, are more confined to frequenting stores that are within walking distances from their homes. 

Conclusion

Food deserts and swamps are found to be good predictors of health conditions and outcomes, and inadequate access to healthy foods poses an immense structural barrier to health and well being. Food swamps, or an overabundance of fast food, particularly cause worse overall health, and they are correlated with higher rates of conditions such as obesity and diabetes [14].

The implications of the correlation of food deserts and swamps with race and socioeconomic status are grave and have profound impacts on marginalized communities in North Carolina and beyond. Rural and minority (specifically Black and Latino) concentrated areas have higher likelihoods of food insecurity than other communities [15]. Given the association between low levels of healthy food access and worse overall health, these communities are thus subjected to higher levels of disease with few ways to combat the issue.

The unequal distribution of food resources in the United States must be addressed in order to ensure equal access to health and wellbeing. Minorities are structurally disadvantaged in their ability to access healthy foods, as they tend to reside in areas with less grocery stores and may lack the means to travel far distances. Ultimately, food deserts and swamps are both a product and agent of enforcement of deep systems of health inequality rooted in race and class, and they must be regarded as serious structural barriers to wellbeing.

References

1. Beaulac, Julie, et al. “A Systematic Review of Food Deserts, 1966-2007.” Preventing Chronic Disease, vol. 6, no. 3, 2009, www.cdc.gov/pcd/issues/2009/jul/08_0163.htm. 
2. Cooksey-Stowers, Kristen, et al. “Food Swamps Predict Obesity Rates Better than Food Deserts in the United States.” International Journal of Environmental Research and Public Health, vol. 14, no. 11, 14 Nov. 2017, p. 1366, www.ncbi.nlm.nih.gov/pmc/articles/PMC5708005/, https://doi.org/10.3390/ijerph14111366.
3. Walker, Jo. ““Food Desert” vs. “Food Apartheid”: Which Term Best Describes Disparities in Food Access?” Seas.umich.edu, 29 Nov. 2023, seas.umich.edu/news/food-desert-vs-food-apartheid-which-term-best-describes-disparities-food-access.
4. Franklin, Jennie. Interview with Adante Hart. 14 November 2018 (Y-0098). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
5. Norwood, Carla. Interview with Darius Scott. 08 August 2018 (Y-0041). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
6. Burwell, Nell. Interview with Lauren Frey. 19 June 2019 (Y-0089). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
7. Somerville, Patricia. Interview with Darius Scott. 06 June 2018 (Y-0051). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
8. Williams-Morales, Andrea. Interview with Madelaine Katz. 23 July 2019 (Y-0137). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
9. Corbera-Hincapie, Montserrat A., et al. “Geospatial analysis of food deserts and their impact on health outcomes in children with cystic fibrosis.” Nutrients, vol. 13, no. 11, 10 Nov. 2021, p. 3996, https://doi.org/10.3390/nu13113996.
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14. Baxter, Connolly, and Yoo Min Park. “Food Swamp versus Food Desert: Analysis of Geographic Disparities in Obesity and Diabetes in North Carolina Using GIS and Spatial Regression.” The Professional Geographer, 4 Mar. 2024, pp. 1–16, https://doi.org/10.1080/00330124.2024.2306642.
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