insights

Accessibility to nutritious, affordable, high-quality food has long been a challenge in low income and rural areas across the US and globally.^1,2 Many communities continue to struggle with food price inflation and supply issues brought on by the COVID-19 pandemic and the Russia-Ukraine war. Everything from demand for staple goods to export and import challenges have hit many communities, but low-income families, the elderly, and children are especially vulnerable to what has become an increasingly pervasive state of food insecurity. Find out what one clinician, who is studying functional medicine, is doing to help.

A “food desert” is defined as an area in which a significant portion of the population has limited access to healthy foods; in urban areas, this means living more than a mile from the nearest supermarket, or in rural areas, 10 miles away.³ The poverty rate in these communities is 20% or greater, or the median-family income is below or equal to 80% of the statewide median family income.³ An estimated 39 million people, or 12.8% of the US population, lived in “low income and low access areas” in 2015.³ During the COVID-19 pandemic, food accessibility challenges have grown even more widespread. Demand has spiked at food banks and pantries across the country, driven in part by the rise in unemployment.¹

Living in a food desert can increase the risk of developing diet-related health conditions and chronic diseases such as obesity.⁴ The World Health Organization estimated in 2020 that low fruit and vegetable intake is a cause of approximately 16 million disability-adjusted lost years of life (1% of the overall total) and 1.7 million deaths (2.8% of all deaths) worldwide each year.⁵

Local farmers markets, however, can serve as community-level interventions, bringing healthy food options to food deserts, and they are viewed as just one way to begin addressing the nation’s chronic health problems.⁶ Farmers markets can be purposefully developed in communities with high rates of poverty, communities of color, and/or communities with limited access to healthy foods.⁴ Studies show promising results. One systematic review indicated the positive effects of fruit and vegetable intake in the prevention of several chronic diseases, including type 2 diabetes, chronic inflammatory bowel disease, rheumatoid arthritis, chronic obstructive pulmonary disease, asthma, and more.⁷ In another study, low income, diabetic shoppers increased their fruit and vegetable intake by 1.6 servings per day using an incentive program based at a farmers market located at a health center.⁸

Jeffrey Geller, MD, a clinician who has been a pioneer in conducting group medical visits, is passionate about delivering care and nutrition to underserved communities. Many people in these communities tend to prioritize “having food” over the “quality of that food,” explained Dr. Geller. As well, due to the nature of food stamp programs, people lean toward purchasing non-perishable foods that will last a long time. This is often at the expense of purchasing produce, which has a shorter shelf life. To help address this access problem, in 1997, Dr. Geller co-created a community garden behind a health center in Lawrence, MA. Later, a nonprofit called Groundwork Lawrence built formal community gardens and open spaces for residents there, helping to bring extra vegetables from farmers markets to the city.

Dr. Geller practices family medicine at the Integrated Center for Group Medical Visits in Lawrence, MA. He is also one of the founding members of Integrative Medicine for the Underserved (IM4US), a nonprofit organization that brings best integrative practices of healing to underserved communities. Here, he reflects on a moment that illustrates the powerful connection between food and community:

“One year our community gardens were run by our teen empowerment group visit program. There was a boy, who at the beginning of the year, was insistent that he would never eat a tomato. We grew the vegetables and gave them to other groups so that they could make salsa for chips. Toward the end of the season, all of the other children encouraged him to eat a tomato. He did and his smile was amazing. He now loves tomatoes,” said Dr. Geller. “Empowerment is trying new things. When I think about all the new things he had to try and do to get to that point of feeling comfortable putting a tomato in his mouth: planting seeds, planning a garden, making supportive friendships, helping others, etc., I realize that something as simple as eating a tomato is really not that simple.”

To be sure, farmers markets like these don’t just offer fresh produce; they work to address the root causes that make it harder for people to eat healthfully, and perhaps most importantly, create a sense of community, well-being, and belonging. Learn more about social determinants of health in IFM’s Applying Functional Medicine in Clinical Practice (AFMCP):

For more nutrition-related content, please read the following IFM-authored articles:

 Food Crops: Nutrient Fluctuations and Malnutrition

  Food First: Dietary Change Improves Outcomes

  Nutrition, Social-Emotional Issues, and Children

References

1. Hake M, Dewey A, Engelhard E, et al. The impact of the coronavirus on local food insecurity. Feeding America. Published May 19, 2020. Accessed May 3, 2022. https://www.feedingamerica.org/sites/default/files/2020-05/Brief_Local%20Impact_5.19.2020.pdf
2. Lewis EC, Colón-Ramos U, Gittelsohn J, Clay L. Food-seeking behaviors and food insecurity risk during the coronavirus disease 2019 pandemic. J Nutr Educ Behav. 2022;54(2):159-171. doi:10.1016/j.jneb.2021.05.002
3. United States Department of Agriculture Economic Research Service. Food Access Research Atlas. Updated March 14, 2022. Accessed May 3, 2022. https://www.ers.usda.gov/data-products/food-access-research-atlas.aspx
4. Freedman DA, Whiteside YO, Brandt HM, Young V, Friedman DB, Hébert JR. Assessing readiness for establishing a farmers’ market at a community health center. J Community Health. 2012;37(1):80-88. doi:10.1007/s10900-011-9419-x
5. World Health Organization. World Health Statistics. Accessed May 6, 2022. https://apps.who.int/iris/bitstream/handle/10665/332070/9789240005105-eng.pdf
6. George DR, Kraschnewski JL, Rovniak LS. Public health potential of farmers’ markets on medical center campuses: a case study from Penn State Milton S. Hershey Medical Center. Am J Public Health. 2011;101(12):2226-2232. doi:10.2105/ajph.2011.300197
7. Boeing H, Bechtold A, Bub A, et al. Critical review: vegetables and fruit in the prevention of chronic diseases. Eur J Nutr. 2012;51(6):637-663. doi:10.1007/s00394-012-0380-y
8. Freedman DA, Choi SK, Hurley T, Anadu E, Hébert JR. A farmers’ market at a federally qualified health center improves fruit and vegetable intake among low-income diabetics. Prev Med. 2013;56(5):288-292. doi:10.1016/j.ypmed.2013.01.018