LOOKING FOR food in rural Mississippi is a challenge. Imagine, for instance, living in Mound Bayou, Mississippi, a small town in the Mississippi Delta with about 1500 people, 44% of whom live in poverty. Thirty-four percent of the adult population in Bolivar County is considered obese; 44% of the adult population in this county has diabetes. While Mound Bayou does have a health clinic, the only source for purchasing food is a convenience store. In this store there are plenty of chips, sodas, and candies, but little in terms of real food. Neighboring Winstonville, a town of about 300 people, has no grocery store and no convenience store. For these 2 towns in North Bolivar County, one has to travel either 6 miles in one direction or 13 miles in another to find a traditional grocery store for food. There is no public transportation service, and both counties have low vehicle access.
Now consider Issaquena County, a small county in the southern part of the Mississippi Delta with a population of about 1300 people and 40% of whom live in poverty. The entirety of Issaquena County has no grocery store. Imagine not having access to a real grocery store. Add to this puzzlement of no access to healthy food through a conventional grocery store, it turns out Issaquena County has one of the highest obesity rates in the nation, with 38% of adults in the county are considered obese.
While the Mississippi Delta may represent an extreme case in the United States, having access to healthy, affordable food is a very real problem throughout Mississippi, and not just in remote, poor counties. Trying to understand this food environment of limited access to healthy affordable food, we are faced with another puzzlement: “How can poor counties have such high obesity rates? Isn't poverty related to being underweight and malnourished?” Indeed, when we think about poverty and hunger in developing nations, we think immediately about children who are thin and underweight. Yet, increasingly, the growing problem in the United States in terms of health has to do with food and the food environment in which people live. The type of food we eat, the food that is cheap and plentiful and easy to access, is often food that has little to no nutritional value, and is high in calories and fat. Malnutrition in the United States is not an issue of being underweight as found in developing nations, rather malnutrition is a case of not eating enough of the right food: malnutrition in the United States is more likely to be associated with obesity.1
The issue of food security and food access in America and particularly in Mississippi is paradoxical: despite abundant agricultural production, there is a large sector of the population that lacks access to nutritious food. This is a problem of significant importance because of the impacts of food insecurity on population health outcomes and well-being.
UNDERSTANDING FOOD INSECURITY AND FOOD ACCESS
Around 1990, the United States Department of Agriculture (USDA) began measuring household food security, a concept centered on understanding whether households have enough consistent food to live a healthy, active life. Food-insecure households, conversely, have difficulty and uncertainty in meeting these basic food needs. The development of this measure emanated from a 1984 US Presidential Task Force on Food Assistance that drew attention to the lack of a good measure of hunger. The USDA has refined the measure over the years to capture the range of severity of food-insecure households and their relationship to hunger. Food insecurity is defined as a lack of access to enough food at all times for all members of the household to be healthy and active. The official measure of food insecurity in the United States is established through the Current Population Survey's Food Security Supplement. Respondents are asked a variety of questions, from “We worried whether our food would run out before we got money to buy more” to “In the last 12 months did you or other adults in your household ever not eat for a whole day because there wasn't enough money for food?”2
Food insecurity is often associated with living in a food desert. The 2008 Farm Bill included language that defined a food desert as an “area in the United States with limited access to affordable and nutritious food, particularly such an area composed of predominantly lower income neighborhoods and communities.”3 Food deserts can lead to higher rates of obesity and other diet-related diseases. While food deserts may not directly cause food insecurity, they do provide good indicators of areas where food insecurity is more likely to occur; these areas are primarily in lower-income communities, which are disproportionately, but not exclusively, populated by African Americans, Hispanics, and other marginalized racial and ethnic groups.4 Research suggests that these households have higher health care costs, increased likelihood of heart disease, diabetes, and higher blood pressure, and health problems associated with access to food.4 Indeed, a comparison between food-insecure and food-secure households indicates that health care costs are almost 50% higher in the former than in the latter.5
Mississippi has the highest food insecurity rate in the United States at 22% compared with 13% for the nation. In Mississippi, 34 of the 82 counties have food insecurity rates over 22% and all of these are considered rural except for 4.6 There are 11 counties in the state in which 20% of the population has both low income and low access to grocery stores; all but one of these are persistent poverty counties.7 The food insecurity rate for the 17 urban counties in the state is 21%; the rural food insecurity rate is 23% (65 rural counties). The child food insecurity rate for Mississippi is 26% (population younger than 18 years). The Figure displays the food insecurity and poverty rates for counties in Mississippi.
In looking at trends in food insecurity from 2001 to 2015, the overall pattern of food insecurity has declined in the United States, peaking in 2010-2012 at about 14%, declining to around 13% in 2013-2105 averages. Yet, Mississippi has consistently had the highest rates in the nation and, rather than declining as most states have, has plateaued and not changed since 2010-2012 averages; it still remains significantly higher than prerecession rates.2
Mississippi usually ranks high in terms of poverty and low quality of population well-being. 2016 population estimates for Mississippi were 2 988 726, non-Hispanic whites represent 59% of the population, and African Americans 37%.6 The poverty rate is 22%, 7 points higher than the national average (15.5%). The major incidence of poverty occurs in the Delta region, about 19 counties that run along the Mississippi River and its neighboring interior, comprising about 4.5 million acres,8 where poverty rates can be over 40%. African Americans comprise about 74% of the Delta population.
The poverty rate among African Americans (36%) in the entire state is more than 2 times higher than the poverty rate among whites (14.2%).6 The darker counties in the Figure that run along the Mississippi River from Warren County in the middle western part of the state, up to Tunica County, reflect the span of the Mississippi Delta and the highest concentration of both persistent poverty and food insecurity, and some of the poorest counties in the nation. The state has an obesity prevalence of 35.5%.9
Of the 82 counties in the state, Mississippi has 50 counties that are considered persistent poverty counties. Persistent poverty is a USDA measure that captures the dimension of time; therefore, these are counties that have poverty rates over 20% over the last 30 years measured by the decennial census. In other words, 61% of Mississippi counties have deep, embedded poverty of 20% or more for over 30 years or more.
In addition, the food environment of the state is characterized by high persistent poverty, low healthy food access, and a primarily rural landscape with low vehicle access, a USDA measure that captures the percentage of housing units located more than 20 miles from a grocery stores, without access to a vehicle.7 Mississippi has 167 census tracts that are considered food deserts, located in 63 counties or 77% of the state. Of these census tracts, 103 have low vehicle access.7 Transportation, then, is an added burden in accessing healthy food.
An example of this type of burden is reflected in Supplemental Nutrition Assistance Program (SNAP) redemption patterns in low food access counties. In Issaquena County as discussed earlier, there is no grocery store. In order to redeem SNAP benefits, recipients have to travel to neighboring counties to buy food. As part of preliminary research examining SNAP transactions and redemption practices, our research team found that over a 1-year period only 5% of SNAP transactions by residents took place in Issaquena County zip codes. What this means is that about 95% of SNAP redemptions for Issaquena SNAP residents took place outside the county. In addition to the burden of finding transportation to purchase food outside one's community and the entire county, the economic loss that occurs for the county from potential spending of SNAP dollars is expended elsewhere. In a 2010 USDA study, the SNAP is found to provide an economic multiplier effect in that “every $5 in new SNAP benefits generates as much as $9 in economic activity.”10 When SNAP dollars are redeemed outside the recipient's counties, there is considerable economic leakage, as well as the increased hardship in trying to access food.
AGRICULTURE POLICY AND THE NUTRITION PARADOX
Food production in the United States has changed dramatically since World War II. Changes due to new technology, changes to meet the increased needs of families and a growing population, increased mechanization, urbanization, and changes in agricultural practices and policies, precipitated the shift from small farms to large-scale agricultural production.4,11 Since the 1940s, there has been a marked decrease in the number of small family farms, once the mainstay of US food production, to a notable increase in commodity production (soy and corn) together with an increase in large-scale agricultural production.11 The United States has experienced significant changes with household food production needs and changes in food production knowledge, including a desire for more “convenience” foods and less food preparation in the kitchen. Add to this an increase in women's labor force participation outside the home since the 1970s, and changing gender roles and expectations within the household labor.12,13 All of this combined reflects a major transformation in US food production and consumption.
United States farm policy since World War II has also changed significantly with an increased focus on supporting commodity production that has, in turn, driven down the costs of commodities such as corn and soybean through government subsidies and support. One of the results of these changes has been the introduction of fructose corn syrup and hydrogenated vegetable oils into the American diet; products that make the costs of snacks, soda, candy, and fats very inexpensive, and indeed economical. Farm policy that buttresses the cheap production of these products in recent years has, at the very same time, had very few subsidies to support the costs of fruits and vegetables.14 Indeed since World War II, there has been a steady, noticeable increase in the price of fruits and vegetable. It is easier, and certainly cheaper, to buy “junk food”—the low nutritional, low cost, long shelf-life, mass-produced food that is found at every corner store, at every convenience store, and on grocery store shelves. In short, farm and food policy is not health policy.
A Centers for Disease Control and Prevention (CDC) report found that American adults were 24 lb heavier in 2004 than they were in 1960.15 As the production of cheap, high-fat, high caloric food, since the 1940s has increased, obesity rates for American adults have skyrocketed since World War II. If we simply look at high-poverty counties and neighborhoods in the United States and overlay these data with obesity rates, we see a striking pattern emerge: the higher the poverty, the higher the obesity rate. In addition, the CDC has identified 644 counties in 15 states that are considered to be part of the Diabetes Belt. According to the CDC, people who live in the Diabetes Belt are more likely to have type 2 diabetes, are more likely to be African American, and less likely to have a college degree. All 82 counties in Mississippi are included in the CDC Diabetes Belt.16
Another critical aspect of the food insecurity concern in Mississippi rests on the structure of agriculture, a sector that in 2016 produced $750 million.7 Mississippi is a highly agricultural state, yet it imports approximately 90% of the food that is consumed.17 Most of the agricultural land in Mississippi is dedicated to commodity crops, particularly soybean and cotton. They are mostly located in the Delta, where poverty rates are highest in the state and the nation. This model of export-oriented agriculture paired with important technological developments in the field has significantly increased food production, but also has generated negative externalities resulting from breaking the link between food production and consumption. This directly relates to the nutrition transition or structural change in the diets of people, “from carb-rich staples to vegetable oils, animal products and sugar.”18 The nutrition transition and its implications are clearly found in Mississippi. Sugars, animal products, and vegetable oils are staples in the diet of Mississippians, many of whom also lack of the necessary vegetable and fruit intake. As Popkin warns, “changes in diet and activity patterns are fueling the obesity epidemic.”19 A 2004 report estimates the financial costs of adult obesity medical expenses in Mississippi were $757 million and approximately $75 billion for the entire nation.20 The authors argue that these medical expenditure costs, which range between 22% and 55% paid by Medicare and Medicaid, would be lower by 7% to 11% if obesity were absent.20
There exist clear diet-related health disparities that are associated with both the nutrition transition and the existence of food deserts in several places in the state. According to Satia, diet-related disparities are “differences in dietary intake, dietary behaviors, and dietary patterns ... resulting in poorer dietary quality and inferior health outcomes ... and an unequal burden in terms of disease incidence, morbidity, mortality, survival, and quality of life.”21 High levels of noncommunicable diseases in Mississippi related to food consumption are evidence of this phenomenon. However, concerns about food insecurity and diet-related health disparities are not exclusive to Mississippi or the United States. The models of commodity and export-oriented agriculture and diet-changing trends have motivated that international organizations like the Food and Agriculture Organization (FAO) or the World Health Organization greater concern about the effects of the nutrition transition on health outcomes and how those are becoming an important public health problem.22 This global research agenda for food calls for, among others, to identify entry points of change in the food system. Alternatives to improve health and nutrition point to the revival of local food systems.
LOCAL FOOD SYSTEMS AND COMMUNITY FOOD INITIATIVES
Mississippi exemplifies that, while there exists an ample supply of food, local variables conspire to limit food availability to populations most in need. Although federal and state efforts have an important impact on the development of strategies to enhance food security, research suggests that increasing food access is a local endeavor.23 The federal government through the USDA has acknowledged the role of local food systems to enhance food access24 and has assigned funding for this purpose in the Farm Bill through programs like Farmers' Market Promotion Program, Local Food Marketing Promotion Program, Community Food Projects, and Federal-State Marketing Improvement Program. However, limited resource, minority, and women farmers still find barriers to access these and other types of USDA programs, and despite institutional efforts, federal funding for agriculture strongly focuses on commodity farming and less in specialty crops (eg, fruits, vegetables, and horticulture). This group of farmers is crucial for the development of sustainable farming and local food systems in Mississippi. Improving access to federal funding for agriculture in general and local food systems in particular to this segment of the agricultural industry can harness the capacity of local food systems to become a viable economic alternative for this group of farmers and an alternative to address issues of food insecurity. Experiences of sustainable farming and local food systems have proven to become an alternative to address these problems effectively.14,25
Given the nature of the problem of poverty, food insecurity, and unsustainability of the current food system in the state, communities have come together to address societal-level issues by understanding the challenges and possibilities of expanding local food systems to provide healthy food options to low-income populations. Food not only is about food production and consumption but also means to build communities and develop capacity for economic growth. Community food initiatives seek to address societal-level issues by understanding the challenges and possibilities of expanding local food systems to provide healthy food options to low-income populations.
Supporting community food system initiatives holds the greatest likelihood of creating a substantive, meaningful, long-term change in food insecurity and addressing key issues of food access. Since this requires systems change, all elements of the food system must be examined. A Primer on Community Food Systems: Linking Food, Nutrition and Agriculture report from Cornell University describes community food systems as a:
System in which food production, processing, distribution and consumption are integrated to enhance the environmental, economic, social and nutritional health of a particular place. The concept of community food systems is sometimes used interchangeably with “local” or “regional” food systems but by including the word “community” there is an emphasis on strengthening existing (or developing new) relationships between all components of the food system. This reflects a prescriptive approach to building a food system, one that holds sustainability—economic, environmental and social—as a long-term goal toward which a community strives.26
The transformative power of implementing this vision of local-community food systems has the potential to create positive and sustainable economic development.27 These system-change efforts are beginning to take shape across the United States, as well as in Mississippi. Increased federal dollars to support these initiatives is imperative in building food-secure, inclusive, healthy communities.
Many communities are embracing the concept of food sovereignty and creating projects and movements around the right to food. Food sovereignty is understood as the right of people to define their own food and agricultural production. The idea arose in the 1990s in response to policies and practices around food security and large-scale agribusiness production of food globally, and the immiseration of small family farmers and producers. Food sovereignty has grown into a global movement about how and where food is produced and who benefits when people are in control of “healthy and culturally appropriate food produced through ecologically sound and sustainable methods, and their right to define their own food and agriculture systems.”28
Local food system initiatives are gaining traction across the country and indeed are becoming fairly mainstream in some parts of the United States. Viewed as “relocalization” and a return to local community food production, these movements are a direct response to the development of big agriculture and the dramatic change in food production since World War II. These initiatives have at their core localized responses to food production, distribution, and consumption. The community food system, in particular, is more concerned with issues of equity and social justice, and grounding this work in community concerns around sustainability, food security, and food access.
Several projects in Mississippi reflect these goals and objectives.
Good Food Revolution—Bolivar County, Mississippi
The Bolivar County Good Food Revolution is a multisector collaboration focused on economic development opportunities and improved health outcomes for residents of Mound Bayou, Winstonville, and Shelby, Mississippi. This project supports and facilitates local food growth and production for the purpose of expanding the local economy, generating jobs, and increasing access to nutrition in the 3 target communities. The goal is to keep food dollars concentrated in these economically distressed communities, specifically supporting enterprises that sell and make available, healthier alternatives to fast foods and processed foods. Their approach seeks to increase capacity to expand and replicate ongoing initiatives, document best practices, increase the health and wealth of communities, and provide local solutions to local challenges, and promote the health and economic benefits of buying locally grown foods, through youth and community engagement. The North Bolivar County Good Food Revolution is working to create a network of growers to scale up their food production to meet increased demand and to establish a mobile market for high-needs communities to access healthy, affordable food.
Mileston Farmer Cooperative—Holmes County, Mississippi
Mileston Cooperative Association (MCA) is based in Mileston, Mississippi, and was established in 1942. Mileston is based in Holmes County, one of the poorest counties in the Mississippi Delta, and the United States. MCA is a farmer cooperative of limited-resource growers, considered socially disadvantaged growers by the USDA. There are currently 13 African American farmers working in the cooperative, along with a youth training program. Mileston is a result of the New Deal Resettlement Administration program created by President Franklin Roosevelt. Under this program rural families were relocated to communities and provided with technical and financial assistance to work government land and eventually purchase the land from the government. Mileston is one of 13 all-black resettlement communities in the United States that formed from the New Deal Resettlement Program in the late 1930s.
The current MCA producers have been working together since 2005 to assist each other in selling produce and commodities. They grow a variety of specialty crops, which they sell locally through farmers' markets and directly to consumers. Recently, MCA has been deeded a local school by Holmes County, for food hub development and community use. The mission of MCA is to enhance the quality of life and health for low-income citizens through economic and community development initiatives, primarily through creating a trained workforce of young people who can work in sustainable agriculture to generate economic development in the high-poverty county and to increase access to healthy food for Holmes County residents who need it.
Mississippi Food Policy Council
The Mississippi Food Policy Council formed in 2010 to focus on food and farm policies that build healthy communities and strengthen local food systems in Mississippi. Their work mirrors national food policy councils that have developed to bring together diverse stakeholders to address food system development, health and nutrition, food access and food insecurity, and food and farm policy. The cross-sector membership of food policy councils ensures that representation from all sectors of the food system come together to promote more resilient food systems in their communities. The relationship between food and health is a clear driving principle of food policy councils, along with economic development for small growers, and particularly socially disadvantaged farmers. The Mississippi Food Policy Council is working to support and develop local county-level food policy councils to strengthen and grow local food system efforts in the state. New food policy councils in Oktibbeha County, Leflore County, and South Rankin County have been formed to expand and strengthen state and county efforts toward sustainable agriculture, food security, food sovereignty, and healthy food access throughout the state.
These are but a few of the projects that are emerging in Mississippi. Many communities across the nation seek to develop programs and initiatives to address hunger and food access and are turning to food policy councils and statewide projects that concentrate on food sovereignty and food system initiatives that link hunger, food-insecure people, and healthy, affordable food access.
IMPROVING THE FOOD ENVIRONMENT: ALIGNING AGRICULTURE, NUTRITION, AND HEALTH POLICY
Finding food is not easy. Finding healthy, affordable food is even more difficult. The food environment in which one lives greatly influences health outcomes for individuals. The food environment is deeply tied to agricultural processes and practices; farm policies over the years have encouraged commodity production while largely ignoring incentives and opportunities for fruit and vegetable production, and small-family farm local food system initiatives.
When delving into the critical issues of health disparities, food access and food insecurity, and the paradox between obesity and poverty, what looms chiefly is the stark lack of orientation between agriculture, nutrition, and health policy. To restate an earlier concern, farm and food policy is not health policy.
The clear disconnect between agriculture policy, nutrition, health policy, food access, and food insecurity has led to conditions that are truly life-threatening in terms of health inequities and health disparities.14 The role agriculture plays in improving health and nutrition cannot be understated. Agriculture farm and food policy that supports and builds local food system initiatives may provide the greatest opportunity as a potential solution to food access and increased health outcomes. The international response to the malnutrition epidemic has been through the FAO, which has recently aligned their strategies to alleviating hunger, malnutrition, and food insecurity by calling for sustainable food systems for healthy diets and improved nutrition. Declaring a Decade of Action to eradicate hunger and prevent all forms of malnutrition, obesity included, the FAO, World Health Organization, and World Food Programme have affiliated a research and programmatic agenda around sustainable food systems as essential for health and well-being.29
Much of the food Americans eat is increasing the likelihood of developing diabetes, becoming obese, and myriad health problems that develop from the type of unhealthy food the food system produces. Accessing healthy, affordable food should not be a challenge, yet it is one of the greatest struggles Americans face. Community-based food sovereignty programs provide the greatest mechanism for and greatest likelihood toward food justice in the United States today. Aligning agriculture and health and nutrition policy to enhance the food environment is not only a local, regional, and national challenge, but a global mandate that all should follow.
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