Health in the Desert

What picture comes to mind with the word desert? I think of the solitary traveler who has been stranded and is hopelessly searching for water; his mind plays tricks as he sees mirages of water pools and fountains. I also think of indigenous nomads who manage to survive with a lifestyle out of the “stone age.” In my imagination they are thin and wiry with stunted growth, accompanied by a few emaciated goats. Their diet is usually not something featured on the Food Network. My only experience with desert landscapes is in Utah, Nevada, California, and Northwest Mexico. Death Valley is perhaps the jewel of those desert lands. It represents a void lacking all the necessities to support life. Not an image I want to associate with health promotion.

Recently health promotion advocates have been using the term “food desert” to describe urban neighborhoods in which few if any healthy food choices are available. These are quite common in medium and large cities. Food deserts are populated mostly with poor and minority residents, who are surrounded with fast food outlets, convenience store fare, and liquor sellers. It has been noted that when the grocery chains locate stores in food desert neighborhoods, the range of products is smaller and the quality and care invested in fresh fruits and vegetables is demonstrably poorer than is expected in more affluent neighborhoods. Typically, a large segment of residents have no cars, so in order to buy more healthy foods in a full service grocery, they have to take public transportation. Ask yourself when was the last time you rode the bus, including a transfer, to carry bags of groceries, with two kids and food stamps. Because most people don’t have such a challenge, they are unaware this is reality for millions of Americans.

In fairness it must be admitted that the lack of quality grocery offerings in many urban neighborhoods is not a simple example of racism and discrimination, except to the extent that markets are discriminatory. Hard rules of supply and demand do not consider social justice. Full service grocers don’t locate in some neighborhoods because area residents can’t buy the extra things whose sale makes a store’s business plan viable. In addition, many residents are not educated to make healthy choices; they understand that you can fill a stomach more cheaply with mass produced snacks than with fresh fruit.

Here is the paradox. In contrast to the geographic deserts where famine conditions are the norm, these deserts are filled with more obese people than in the affluent suburbs. Part of this is because of diabolically ingenious technology which has brought an oasis of high calorie low price junk food which is sold in the retail outlets on every corner. Another reason is that these neighborhoods are also exercise deserts. Usually there are no fitness centers, parks are unkempt and unsafe, sidewalks are broken and uninviting and there is a backdrop of fear because of gang violence and street crime. Residents again are typically not educated to value physical activity, and they more often than not will work for an employer who provides no facilities nor incentives for workers to stay fit.

People living in food deserts are inordinately exposed to the TV media world; it is another kind of desert. The media desert presents a diet consisting of soft drinks, alcoholic beverages, and fast food. Further, health is largely a function of taking medication. This is an idea desert in which really life-producing health information is nowhere to be found.

In Louisville the Health Department and the Mayor’s Office have started a project called “Health In a Hurry.” The idea is to work with corner store owners, providing financing and business support to create fruit and vegetable sections in their stores. There is also an effort to work with residents in the surrounding area to build a market for these healthy foods. Food desert neighborhoods are being targeted. There is one of these about two blocks from where I’m writing. It has a designated area for produce where none was to be found before. So far it is working; sales are picking up. On the other hand, the outside of the store is plastered with cigarette posters and banners.

Two steps forward, one step back. Patience is required. It takes a while to get out of a desert.