FERN’s Back Forty: Why ‘access’ to healthy food became America’s response to its dietary woes

Early in Priya Fielding-Singh’s important new book, How the Other Half Eats, the author, a sociologist at the University of Utah, has an epiphany: Some of the mothers she is writing about, those who live below the poverty level or precariously close to it, will spend money that could go to rent or bills on restaurant meals or junk food for their kids. They don’t do it because they are irresponsible or unconcerned about dietary health. They do it because it is one of the few ways they have to regularly say ‘yes’ to their children, to make them happy—to comfort them the way a “good mom” should.

“On a daily basis, food was the thing [Nyah] and her girls could afford and the thing they could look forward to,” Fielding-Singh writes. “A one-dollar doughnut, a two-dollar ice cream, a three-dollar burger.”

Julie, a more affluent mom in the book, can afford to send her kids to summer camps, take them on family vacations, and buy them cell phones. For her, saying no to their requests for junk food doesn’t mean the same thing as it does to Nyah. In Julie’s world, her dietary vigilance is considered virtuous, the mark of a “good mom.”

By contrasting the circumstances of Nyah and Julie, Fielding-Singh shows how poverty creates its own logic. The choices Nyah makes are just as reasonable, when considered in proper context, as those made by Julie. Yet society judges Nyah as an ill-informed parent at best, derelict at worst.

Fielding-Singh uses these nuanced portraits of Nyah, Julie, and a handful of other mothers to complicate a simplistic idea that has dominated food-reform efforts for years: The belief that giving poor people physical access to grocery stores, farmers’ markets and other purveyors of “healthy” food will improve their diet, mitigate obesity, and help forge a healthier nation.

Her book has gotten a lot of attention, with reviews and author interviews by NPR, CNN, The New York Times and The Washington Post, among others, and deservedly so. But it is telling that her argument about access feels revelatory, when over the last decade study after study has shown that access alone does virtually nothing to change what people choose to buy and eat.

The federal government, meanwhile, continues to spend millions of dollars a year on “innovative food retail and food system enterprises that seek to improve access to healthy food in underserved areas.” And pundits and activists continue to bang on about the scourge of “food deserts” and “food swamps.”

All the mothers in Fielding-Singh’s book, no matter their socioeconomic situation, struggle in various ways to consistently feed their kids a healthy diet. Yet she makes clear that the real culprit in the story of dietary inequity—the obstacle that cannot be surmounted by personal discipline, education, or the addition of a Whole Foods supermarket—is poverty.

The ways that poverty affects behavior are well established. In their 2013 book, Scarcity: Why Having So Little Means So Much, Sendhill Mullainathan and Eldar Shafir describe how not having enough of something—time, money, friends, etc.fundamentally changes the decisions we make regarding those things. “Scarcity is more than just the displeasure of having very little,” they write. “It changes how we think.”

And poverty, with its lack of discretion—one cannot simply take a break from being poor—is its own special case in terms of how scarcity “captures the mind.” Poverty is tedious, stressful, and frightening. Poor parents tend to have more pressing concerns than a healthy diet when it comes to their kids: Will they join a gang? Finish school? Be safe at home alone while the adults work? They worry about being evicted or having the power turned off because of unpaid bills.

Poverty also is expensive. As Fielding-Singh explains, the water from Nyah’s tap is not safe to drink, so she spends $40 a month on bottled water. Nyah can’t afford a new car so she is constantly paying for repairs to her old one.

The story of how providing access to better food, rather than working to alleviate poverty, became a primary strategy for solving the nation’s dietary-health crisis was laid out in a 2018 article, “Let Them Eat Kale,” published in the Fordham Urban Law Journal. It is a case study in both America’s preference for silver-bullet solutions, and its commitment to “individual responsibility” over collective action for the common good.

The idea of increasing access to deal with malnourishment arose in the 1970s, as the Green Revolution’s higher crop yields failed to end famine in developing countries. The problem wasn’t a lack of food, critics argued, but rather policies that perpetuated a lack of purchasing power among the poor—including international food aid, which was said to increase dependency. It was part of a critique of the problem of food insecurity, voiced by economist Amartya Sen and others, that focused on poverty as the root cause.

But starting in the 1990s, the access strategy was co-opted by the emerging neoliberal consensus in the West. As Bill Clinton’s administration pared back the social safety net, exacerbating food-insecurity in the process, “increased access” became a convenient response to the growing ranks of the hungry—one that pumped public money into retail grocery chains to entice them to return to the urban neighborhoods they had abandoned decades earlier. Not coincidentally, this is when the term “food desert” entered the conversation.

The access solution appealed to municipal leaders who were eager to revitalize the inner city after years of disinvestment. It appealed to public health authorities who needed a politically feasible way to address the emerging obesity crisis. And it appealed to the nascent food-reform movement and its allies in the philanthropic world who focused on actionable strategies such as cooking classes, nutrition education, and moral suasion in their quest to change dietary habits.

Over the next two decades, hundreds of millions of dollars flowed into research and development for access initiatives. In 2010, the Obama administration made access a pillar of First Lady Michelle Obama’s Let’s Move! campaign to fight childhood obesity.

The problem of what poor people ate in America became “framed as a market failure that could be addressed … through incentives for, and private-public partnerships with, food retailers,” write the authors of “Let Them Eat Kale.” But the context in which food decisions are made — like poverty — got left behind.

It would be nice to believe that this book will finally put an end to dietary-reform strategies that, as Fielding-Singh writes, “present a structural problem as an individual one.” It seems unlikely, though. Moralizing, paternalistic campaigns by the upper classes to “improve” how the lower classes eat have been the norm in this country.

But the bigger reason we are likely to keep getting it wrong is found in Fielding-Singh’s conclusion, which includes a familiar litany of policies that actually could help ease poverty in America, and thus the dietary mayhem that accompanies it. Things like investment in affordable housing, paid family leave, universal healthcare, a living wage, and banning junk food advertising to children. For years now, such proposals have filled the conclusions of books and articles by any number of well-intentioned reformers.

The exhortation is always, as Fielding-Singh dutifully writes, for the nation to assume “collective responsibility” for the idea that a nutritious diet is a human right to which every person is entitled. This in a country where we can’t even summon a collective responsibility to wear masks during a pandemic that has killed 800,000 of our fellow citizens. We’ve known for decades how to ameliorate poverty in America. We’ve chosen not to do it.

FERN’s Back Forty: Why ‘access’ to healthy food became America’s response to its dietary woes