- Availability of healthy food options. Economically disadvantaged groups often live further from stores that offer healthy food options. Grocery stores in low-income neighborhoods typically offer a less diverse food selection and fewer fresh fruits, vegetables, meats and dairy foods (Morland, 2002).
- Food selection. When grocery shopping, low-income individuals are less likely to buy a variety of fruits and vegetables, and buy them less often, than higher income individuals (Turrell, 2002). This is often thought to be the result of the higher cost of such foods.
- Lack of transportation. Lack of personal transportation and limited public transportation options further prevent low-income individuals from accessing larger supermarkets (Morland, 2002).
- Fast food restaurant prevalence. There is a higher prevalence of fast food restaurants in low income neighborhoods. Low-income populations have more convenient access to fast food, which could be linked to increased consumption of fast foods (Block, 2004).
- Demand for healthy food. Low availability of healthy foods in low-income neighborhoods tends to be due to a lower demand for such foods (Yancey, 2004).
- Socioeconomic position. Often healthier foods are too expensive for low-income individuals to afford. Therefore, low income populations buy less expensive, high fat, high sugar content foods (Drewnowski, 2004). Individuals with low education levels, blue-collar employees and those in economically-disadvantaged households are less likely to purchase foods high in fiber and low in salt, sugar, and fat (Turrell, 2002). This could be the result of limited knowledge about the importance of and how to purchase or prepare these healthier foods.
- Stress. Low-income individuals face social and economic pressure unlike other populations, which can make healthy eating a lower priority compared to other issues (Turrell, 2002).
Strategies to address these considerations
- Improve availability of healthy options. Work with local community and faith-based organizations, businesses, and governmental leaders to increase the healthy options available at existing markets and restaurants (Zenk, 2005). Some communities have offered grants, loans, and tax benefits to stimulate the development of neighborhood groceries, farmers’ markets, community gardens, and farm-to-cafeteria programs (Institute of Medicine, 2005).
- Improve access to healthy food choices. Creating a network that includes community groups, local government, nonprofit organizations, local farmers and food processors can help expand accessibility (IOM, 2005). Collaborating with city or county officials and urban planners on land use planning can limit the number of fast-food restaurants in a community (Larson, 2009). It may be useful to work with city officials, urban planners, transportation departments, and faith-based organizations to develop city- or county-wide strategies related to land use planning and transportation so as to provide equal access to healthy food choices (Yancey, 2004).
- Increase usage of supplemental food and nutrition information programs. It may also be useful to work with healthcare providers that serve low-income communities to enhance their ability to convey appropriate nutritional counseling and program referrals (Hartman, 1997).
- Helping individuals get to the right place at the right time, and with necessary information, to enroll or participate in food and nutrition assistance programs can increase usage of food assistance programs (Strasser, 1991). Case management has also been suggested as a mechanism to help individuals overcome barriers and increase use of food assistance programs (Heslin, 2003).
- Address cost barriers. Work with local government and business leaders to develop strategies to reduce food costs for lower income communities (Drewnowski, 2004).
- Tailor to the community. It is important to develop strategies that work in partnership with disadvantaged groups, such as low-income communities, to meet the particular needs of the community (USDHHS, 2000).
- Involve the priority populations. It is important that individuals who are from the community of interest take an active role in planning, implementing and evaluating interventions (Bank-Wallace, 2002).
- Address participant needs. Consider providing childcare, transportation, or any other type of assistance that will allow increased participation in nutrition intervention programs (Bank-Wallace, 2002).
- Engage community stakeholders. Leadership and active participation by community members, especially health care providers and community and religious leaders, can strengthen the credibility of and respect for the intervention (Bank-Wallace, 2002).
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