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It's Not the Food We Can't Get. It's the Food We Can.

282678968_677a7e94bc.jpgJane Black takes note of an interesting new study (crummy graphs though. Sigh.) out of the USDA looking at the question of so-called "food deserts" -- areas barren of supermarkets or other ways of accessing fresh and healthful food. The takeaway, Jane says, is that worrying about food deserts gets it backward. There's very little evidence connecting access to fresh food and lower body mass indexes. Indeed, only 2.2 percent of Americans live a mile or more from a supermarket and don't have access to a care.

The problem, it seems, is the opposite: food swamps. Areas dense with fast food and convenience stores. As the USDA puts it, "Easy access to all food, rather than lack of access to specific healthy foods, may be a more important factor in explaining increases in obesity." The concentration of the obesity crisis in high-poverty areas thus brings us back to a pretty well-accepted hypothesis: The problem is with low-income areas where the cheap food is the bad food.

It's really hard to conceive of a trickier public policy problem than this one. You can solve the problem of people being unable to choose an apple and they still won't choose an apple. People like crap food. It's convenient. Brilliant, highly paid scientists have spent millions of dollars precisely calibrating it to the modern palette. Innovative, award-winning advertisers have spent billions of dollars making us want it. And it's cheap.

You can ask, of course, why it's a public policy problem. And the answer, in short, is that we're not willing to let diabetics die in the streets. And if that's the case, then it's a public policy program, because a world in which 25 percent of Americans are chronically ill by middle-age is a world in which we can kiss our low tax rates goodbye. I'm increasingly coming to the position -- a position held by Tom Philpott and others -- that at some point, public money is going to have to make healthy food cheaper. People instinctively rebel against that idea, but is it really so much better to pay for the consequences of unhealthful food later?

But I'm not sure that that would be nearly enough. Actually, allow me to rephrase. I'm absolutely sure that wouldn't be enough. I'm not sure, at this point, there are answers. Maybe gastric bypass surgeries will become really cheap.

Photo used under a CC license from Flickr user Christian Cable.

By Ezra Klein  |  June 25, 2009; 4:56 PM ET
Categories:  Food  
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Rather than spending new public money, why not just quit subsidizing carbohydrates like corn (of course, the farm lobby is the problem politically). Personally, I wouldn't consider any new subsidies until the old ones are dead.

Posted by: RobertPrather1 | June 25, 2009 5:56 PM | Report abuse

Ezra, have you read Cutler and Glaeser's study on access to food and obesity rates? They argue that the increase in obesity in recent years can largely be attributed to a decline in preparation time -- not dissimilar to the argument you're making here.

Posted by: davestickler | June 25, 2009 6:01 PM | Report abuse

I can anecdotally back up the idea that less prep time (or longer working hours) matter: I've seen people come back from work to well-stocked fridges and larders, and because there's nothing to warm through in the microwave or ready-to-eat, decide to have popcorn for dinner because they're too mentally drained to put together ingredients for a quick meal.

Detaching health insurance from employment -- or at least, having a situation where people aren't working to keep their insurance -- might address some of that. Basic food education may help: Jamie Oliver's work on this can seem airy and naive, but his heart's in the right place. But it may well be that genuine necessity is the only thing that does the job.

Posted by: pseudonymousinnc | June 25, 2009 7:30 PM | Report abuse

Note carefully what Ezra's saying: if the Government pays for health care, it gets to determine what you can eat.

Posted by: tomtildrum | June 25, 2009 11:30 PM | Report abuse

I was trained to work in the food industry; and currently work in the health/fitness arena, so I've certainly developed some insights on the issue over the years.

People develop their food/eating habits early in life; so turning unhealthy lifestyles around is no small feat - it takes a lot of energy and time on my part, working one-on-one...and that's with folks who are willing and motivated. The take-home lesson is that one hell of a lot of social support is needed for effective change to occur - something which is given only lip service (at best) in most educational efforts (whether they're produced/sponsored by for-profit or governmental entities). Most people are expected and encouraged to go it alone - which means failure is written into the vast majority of attempts.

IMHO, any serious attempt to turn things around will need to put $$$ into free or low-cost community-based programs to provide that support...otherwise it'll all add up to expensive FAIL.

Posted by: elowe1 | June 26, 2009 9:37 AM | Report abuse

those lucky people, with no access to a care! Let a smile be your umberella as you're singing in the rain!

Posted by: bdballard | June 26, 2009 12:45 PM | Report abuse

An inherent issue is that there is no standard to what is considered “healthy.” I know that the grass-fed steak and butter that I consume regularly is quite healthy, but in the misguided war on fat they would quite possibly be considered unhealthy. Similarly as a diabetic I know that grains are severely detrimental to the health and waistlines of many, yet “healthy whole grains” are continually promoted as such when the truth is quite the opposite.

Posted by: mb129 | June 26, 2009 2:49 PM | Report abuse

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