The Nourishing Change newsletter is a forum for sharing information and resources to enrich our conversations and efforts to organize for the most basic of human rights - the right to food.  The content of these newsletters will seek to illuminate the particular conditions that, when all are realized, define the right to food: food that is accessible both physically and economically; food that is adequate for optimal health and nutrition; food that is available through means that promote self-determination and dignity; and food that is sustainable produced and consumed and promotes the health and well-being of the environment.

Why the framing of this newsletter around the "right to food?" Charitable programs combined with government food assistance and entitlement programs cannot accomplish the goals of ending hunger and food insecurity.  WhyHunger believes that it is time to reframe the narrative on what it will take to end hunger in the United States and to deepen our understanding and support efforts that address the root causes of hunger, such as racism, falling real wages, rising inequality in income and assets. The conversations and shared learning that will shift strategic actions must incorporate the people at the front lines of hunger and food insecurity in their design and implementation. The Nourishing Change newsletter is but one seed in this emerging landscape of a just and robust people-centered future.

 

In this quarter's issue of the Nourishing Change newsletter, we are highlighting topics, stories and content at the intersection of hunger and health, focusing on the indivisibility of the right to good health and the right to good food.

Working at the intersection of hunger and health first requires understanding the social determinants of health

Hunger and food insecurity are symptoms of poverty, and poverty influences the food choices that people make.  Increasingly food access organizations are working at the intersection of hunger and health by developing and implementing programs that increase their clients' access to healthy food by stocking fresh fruits, vegetables and meats for distribution and/or providing opportunities for clients to learn to grow their own food; by increasing their buying power with SNAP dollars (through nutrition incentive programs such as Double Up Bucks or the Farmers Market Nutrition Program); and by partnering with community health clinics to provide veggie prescriptions.

These food access organizations are employing creative strategies to the economic barriers that prevent those living with food insecurity to access food that will boost their mental and physical health. By increasing access to affordable, healthy, fresh food these programs seek to address the inequities that exist within our food system for many communities, especially communities with low-income levels and communities of color.

However, health is a result of both individual and environmental factors. And poverty is but one environmental factor that determines access to healthy, affordable food. And access is but one condition of ensuring the right to food.

In this quarter's Nourishing Change newsletter, we are exploring the following question:  Is providing access to healthy food enough to address the food insecurity and poor health outcomes that have become so entrenched in many communities, especially community of color and those experiencing persistent poverty? 

Part of the answer may lie in looking at the full range of environmental factors that influence a person's health, more commonly known in the public health world as the social determinants of health. Health is affected by individual choices to some extent AND - to a much larger degree -- the environment and community where one lives; the practices that define a whole culture; as well as institutional policies and practices that have been established. Social determinants of health are in part responsible for the unequal and avoidable differences in health status within and between communities.

The most common understanding of the social determinants of health within the public health sector is depicted in the following graphic:

Each of these five determinant areas reflects a number of critical components or key issues that affect health outcomes. (1) Economic Stability: poverty, employment, income level, housing stability and costs (2) Education: high school graduation, enrollment in Higher Education, language and literacy, early childhood education (3) Social and Community Context: social cohesion, civic participation, perceptions of discrimination and equity, incarceration (4) Health and Health Care: access to affordable and comprehensive health care, access to primary care, health literacy (5) Neighborhood and Built Environment: access to healthy and nutrient-dense foods, quality of housing, crime and violence, environmental health.

In this version, access to healthy food is just one critical component in determining health outcomes. But here's the thing: This diagram, according to its graphic representation, assumes that these determinants collectively affect each person's health in the same way, all things being equal.

Let's look at a different depiction of the social determinants of health that was developed as a part of Gathering Wisdom, a First Nations health conference in Canada. 

This graphic includes the same social determinants as the previous slide. The difference is that this version recognizes that all things are not equal. It shows that there other factors at play - systems of oppression that affect women and people of color more persistently than others and that show up in the form of racism and sexism rooted in a history of colonization and social injustice. These systems of oppression create persistent inequities in access, resources and opportunities that impact health. In other words, this graphic is representative of the reality of most societies in today's world where certain communities and groups of people have more power and privilege than others.

Because this depiction was created by the community that is directly affected by these issues, one could argue that it shows a fuller and deeper analysis of what needs to be addressed to bring about better health in their community.  It also underscores the importance of a culturally appropriate lens. The First Nations communities that created this graphic asked: Does the land where I live have clean water, are there good jobs, health services, safe housing? How does racism, colonization, or local control of resources affect wellness of both the individual and of a nation? What about the intersections between wellness and the justice system, self-determination, child protection, and revitalization of language?

All of these factors play a role in poor health outcomes and food insecurity, and are part of a complex web of systems, policies, practices, and conditions that lead to imbalances of power and privilege and the inequities that persist in who suffers from hunger or lives with food insecurity, and who has the potential for the best possible health outcomes or suffers from a shorter and disease-riddled life.

What all of this illustrates is that hunger and food insecurity usually exist in conjunction with other systemic issues in a person's life, such as low-wage jobs, the high costs of housing, healthcare and childcare. These factors are then compounded by racism and sexism. If we bring the impact of these systemic issues back to the individual level it can be summed up in one word: STRESS. These external factors (or social determinants) from an individual's environment get internalized as stress. Repeated and chronic stress creates wear and tear on the body and that causes disease and/or makes people more susceptible to disease.

So the questions we want to lift up and encourage us all to live into are the following:  How can we make our programs more equitable for those who are participating in and benefiting from them? How can we demonstrate and value people as experts in their own experience? How do our programs change or evolve when we use a lens that considers the root causes of hunger and poor health in the first place?

Don't call my neighborhood a food desert," Karen Washington, founder of BUGS and the Garden of Happiness said of her beloved Bronx. "We have food. We have lots of food. What we don't have is good food. I like to call it food apartheid."

The most common definition of a food desert is a geographic region in the country without access to fresh fruits, vegetables, and other healthy food. The lack of affordable, healthy food options in these areas is largely attributed to a lack of grocery stores, farmers' markets, and healthy food providers. The emphasis is on physical access first and foremost. Some researchers say that food deserts tend to be under-reported because the classification systems most often used take small corner grocery stores, which primarily sell packaged food, to be the same as grocery stores with fresh produce, like Safeway and Whole Foods. Residents living in food deserts also have a hard time finding foods that are culturally relevant and that meet their dietary restrictions.

 

The term food desert is not uniformly embraced, particularly among frontline leaders of communities that are designated by researchers as food deserts. Food apartheid, according to these leaders, is more resonant with their lived experience and their understanding of what contributes to insufficient food access and the health consequences associated with it. 

 

First, desert as a metaphor is misguided. Deserts are an important part of the Earth's complex ecosystem and are misleading in their appearance as barren and dry. In the Southwest, for example, indigenous communities have relied on deserts for a varied and abundant diet for thousands of years, interrupted only by forced displacement of native communities by the U.S. Government.  Desert foods include pinon nuts, cacti (sauguaro, prickly pear, and cholla), mesquite beans, agave, insects, berries and seeds. Also, wild game such as turkeys, deer and rabbits. And dryland farming is  a widespread tradition that is beginning to see a resurgence, especially among the Tohono O'odham whose dryland farming practices go back 4,000 years.  This sovereign tribe cultivates squash and tepary beans, among other crops. 

Second, food apartheid speaks more directly to the ties between insufficient healthy food access and racialized economic policies that erect and maintain structures of segregation .  Approximately 24 million people in the U.S. live in low-income neighborhoods located more than 1 mile from a supermarket. African Americans are half as likely to have access to chain supermarkets while Hispanics are a third less likely.  Applying a lens of race to the phenomenon experienced in communities with very low access to healthy food, makes it necessary to look deeply at the intersections between these communities and the development and planning policies that have resulted in residential segregation, commercial flight from and redlining in urban communities, as well as supermarket scarcity. 

 

Further, the effects of supermarket consolidation , such as the recent acquisition of Whole Foods by the shopping behemoth Amazon , make food segregation even starker.The argument that being able to lower the prices due to economies of scale  will make healthy food even more available to more people because they can buy in bulk and ship anywhere sounds great, but think of who it leaves out. Super consolidation adds to food apartheid in that there will just be more emphasis on big stores and on-line shopping instead of ensuring that there are fresh foods in the stores that currently exist in low-income neighborhoods. Consolidation is thought to make food affordable and more accessible but that doesn't make it more available.

 

Given that the problems resulting from food apartheid are structural in design, the solutions, therefore, must focus on transforming structures.  It's long-term work that involves understanding how race and economics are intricately tied and it involves community members coming together to ask the right questions, to develop a shared understanding of the historical actions which led to the current and seemingly intractable structures, and then to envision something different and begin to work towards it. What is the genuine buying power in these communities?   How could local policies help put residents to work growing or distributing food? What are the existing and potential food growing resources in so-called food deserts?  Is there vacant, unused land that could be put to use growing food for the community? What are the local, state and federal policies either encouraging or discouraging access to economic power, access to fresh food, clean water and access to the possibilities for living a life of dignity and agency?

 

Much like the social determinants of health, food apartheid requires us to examine hunger and food insecurity and its structural roots and use a systems approach to solve it. One could argue that food apartheid and not simply food access is the true social determinant of health. 

Communities around the country are actively ending food apartheid and creating alternatives by addressing problems at their roots and through the lens of the social determinants of health.  Read some of their stories here.  

Housing is an important social determinant of physical and mental health and well-being. As such housing instability and food insecurity go hand in hand.  According to the Urban Institute, low-income families with access to affordable housing have more food security. According to their research, three-quarters of families earning less than $15,000 annually face severe housing burdens resulting in the need to spend more than 50 percent of their income for housing. 

The Three-Quarter House Tenant Organizing Project (TOP) is a collaboration between Neighbors Together and  Mobilization for Justice . TOP is a group of current and former three-quarter house tenants who are organizing residents of these same houses to ensure their rights and safety, and working to improve unjust conditions and illegal treatment of people within the houses. Three-quarter houses are private homes that rent beds to single adults, and purport to be supportive programs, even though they are unlicensed and unregulated by any government body or licensing agency. TOP is working for three-quarter house reform that will create safe and stable affordable housing for people trying to get back on their feet.

 

TOP worked closely with a New York Times reporter from fall 2014 through spring 2015, which resulted in a May 31, 2015,   front page story in the NY Times , exposing the three-quarter house industry and highlighting the abuses tenants suffer.

Read the report on three-quarter houses that TOP members produced in conjunction with the Prisoner Reentry Institute of John Jay College, Neighbors Together, Mobilization for Justice, and the Legal Action Center here . 

We spoke to three of our partners to discuss the work they are doing around hunger and health.

 

Alissa Wassung, Director of Policy & Planning at God's Love We Deliver:

Food is Medicine is more important now than it ever has been because it remains a low-cost, high-impact health care solution, particularly for the system's highest risk, highest need and highest cost patients.

Nutrition plays a critical role in achieving positive health outcomes and reducing healthcare costs. The question for skeptics is, "How can we not address the nutrition needs of the most vulnerable among us, from both a human and an outcomes perspective?"

 

Stephanie Solomon, Director of Education & Outreach from Mother Hubbard's Cupboard:

We know that stress levels are exacerbated by the experience of poverty, and that stress, arguably, has a more significant influence on health than food.

There are many cultural barriers that keep those experiencing poverty isolated. We know that food is an incredible vehicle for building connections and bringing folks together. We strive to create safe, stable, nurturing relationships and environments as our foundation for community building.

Gregory Silverman, Executive Director at West Side Campaign Against Hunger:

In a world with increasing rates of hunger, homelessness, joblessness, the need is growing and therefore our ability to have enough healthy food for our customers in of highest import.

In all communities we need to advocate for more support to increase access to healthy foods for our community members.

Read more of their thoughts here. 

"Pathology of Displacement: The Intersection of Food Justice and Culture"

Our Food Justice Voices series is intended to amplify the voices and experiences of grassroots leaders that aren't heard enough, while creating awareness and educating readers on various issues connected to hunger and poverty. In Pathology of Displacement: The Intersection of Food Justice and Culture, storyteller, healing practitioner and food justice organizer Shane Bernardo tells the story of displacement that his Pilipino family experienced and how he is working to reclaim ancestral subsistence practices that connect him to land, food and his roots. In this piece Shane breaks down what was lost due to colonialism and how we can fight to get it back to truly achieve a real "food justice" movement.

Read the issue here.