Access to Foods That Support Healthy Dietary Patterns

A dietary pattern represents the totality of what individuals habitually eat and drink, and the parts of the pattern act synergistically to affect health. Healthy dietary patterns can help lower the risk of chronic disease.^1,2,3,4 According to the Dietary Guidelines for Americans, 2020–2025 (Dietary Guidelines), a healthy dietary pattern consists of nutrient-dense forms of foods and beverages across all food groups, in recommended amounts, and within calorie limits. The core elements of a healthy dietary pattern include consumption of vegetables of all types, fruits, grains (especially whole grains), low-fat or fat-free dairy, protein foods, and oils while also paying attention to portion size.³ The Dietary Guidelines also recommend limiting foods and beverages higher in added sugars, saturated fat, and sodium, and limiting alcohol intake.³ A healthy dietary pattern is not a rigid prescription but rather a customizable framework of core elements tailored to personal, cultural, and traditional preferences.³

Access to foods that support healthy dietary patterns supports health not only at that point in time but also across the lifespan and possibly for future generations.³ Consistent evidence demonstrates that a healthy dietary pattern is associated with beneficial outcomes for all-cause mortality, cardiovascular disease, overweight and obesity, type 2 diabetes, bone health, and certain types of cancer (breast and colorectal).^3,5 Having access to healthy, safe, and affordable food is crucial for an individual to achieve a healthy dietary pattern.

There is a relationship between the inability to access foods that support healthy dietary patterns and negative health outcomes. For example, a recent study assessed the link between food-related hardships like food insecurity (defined as the inability to acquire adequate food) on obesity.⁶ Residents of neighborhoods with fewer fresh produce sources and plentiful fast-food restaurants and convenience stores were at a higher risk of obesity and diabetes.⁶ Lower rates of obesity and diabetes were found in areas with increased access to healthy foods and a higher density of full-service restaurants and grocery stores.^6,7 The food environment surrounding schools can impact children and adolescents as well. A study found that students with fast-food restaurants near (within a half-mile of) their schools consumed fewer servings of fruits and vegetables, consumed more servings of soda, and were more likely to be overweight than youth whose schools were not near fast-food restaurants.⁸

There are barriers to, and disparities in, the accessibility and availability of foods that support healthy dietary patterns.³ Distance to grocery stores and lack of transportation are barriers that can inhibit access to healthy food options. Data from 2015 show that the average distance from U.S. households to the nearest supermarket was 2.19 miles.⁹ Another report found that 23.5 million people live in low-income areas that are further than 1 mile from a large grocery store or supermarket. Individuals without a vehicle or access to convenient public transportation,¹⁰ or who do not have food venues with healthy choices within walking distance, have limited access to foods that support healthy dietary patterns.¹¹ Predominantly Black and Hispanic neighborhoods have fewer large chain supermarkets than predominantly White and non-Hispanic neighborhoods.^9,10 A study in Detroit found that people living in predominantly Black low-income neighborhoods travel an average of 1.1 miles farther to the closest supermarket than people living in predominantly White low-income neighborhoods.¹² Lack of access to foods that support healthy dietary patterns may have a greater impact on members of racial/ethnic minority communities, residents of low-income communities,¹¹ and those living in rural areas, especially older adults, due to the other social and environmental determinants they tend to face.^13,14 In addition, for those who do not have access to a car or public transportation, the cost of travel time to find healthier options in addition to out-of-pocket expenses may be too high.¹⁰

Affordability also influences access to foods that support healthy dietary patterns. Low-income groups tend to rely on foods that are cheap and convenient to access but are often low in nutrients.^10,13 Fresh fruits and vegetables and other healthier items are often more expensive at convenience stores and small food markets than in larger chain supermarkets and grocery stores.^10,11,15 A summary of recent research on this issue indicated that “low-income residents who shop for food in their neighborhoods may pay more, on average, for produce (apples, bananas, oranges, carrots and tomatoes).”¹⁶ Price reductions of healthier food choices can contribute to increased purchasing of those choices.¹⁶

Improving access to foods that support healthy dietary patterns is one method for addressing health disparities and population health. Several strategies that aim to improve diet by altering food environments are being considered and implemented.^8,10 Examples of programs to address access to and affordability of healthy foods include: The Gus Schumacher Nutrition Incentive Program, Centers for Disease Control and Prevention (CDC) Food Service Guidelines, and various state and local programs. The Gus Schumacher Nutrition Incentive Program incentivizes the purchase of fruits and vegetables, among participating households, in an effort to expand access to low-income communities.¹⁷ CDC Food Service Guidelines provide structure for facilities like schools, private work sites, and venues to improve food safety practices and increase access to healthier food by design.¹⁸ One example of a local-level program is Racial and Ethnic Approaches to Community Health (REACH), which works with urban, rural, and tribal communities in underserved areas with inadequate food systems to improve their access to healthy foods.^19,20 Another study has shown that a small financial incentive increased the use of Supplemental Nutrition Assistance Program (SNAP) benefits in participating farmers markets — resulting in increased access to healthy foods.¹⁹ Several strategies have also been proposed to encourage more equitable access to healthy food choices, such as “attracting and opening supermarkets in underserved neighborhoods, selling healthy foods at reduced prices, and limiting the total number of per capita fast food restaurants in a community.”¹⁰

Increased evaluation and funding for existing efforts is needed to continually improve programs and resources for affected communities.^8,10 This additional evidence will facilitate public health efforts to address access to healthy food choices as a social determinant of health.