Food Deserts: Ethical and Medical Concerns

Food deserts can arise in rural areas without supermarkets for miles and urban areas with neighborhoods needing access to groceries or healthy food options, even in the presence of gas stations, fast food, and other processed food options (Tulane). Many of these areas are also highly impoverished, meaning that price markups and transport costs make it unrealistic for individuals to afford food. The limited access to healthy food options in these areas compounds existing challenges, making it nearly impossible to find nutritious food locally and often too difficult to travel elsewhere for healthy alternatives. For people in food deserts with dietary restrictions, the situation is even more restricted due to their specific nutritional needs, and the fact that nutritious food that fits those needs is even harder to acquire than it can be outside of food deserts.

Numerous studies have analyzed this phenomenon’s devastating effects on public health. From weight gain to metabolic disease (e.g., diabetes and obesity) and decreased life expectancies, low-income regions face many medical issues linked to poor diets. These areas also lack access to medical care that tackles these issues, amplifying these communities' perpetual cycle of poor health characteristics. In an era where produce and fresh food are more widely available than in history, the inequities that create these food– and health– deserts stand out more than ever. Why have these regions been left behind? What drives the manifestation of these inequalities, both in rural America and the heart of urban areas? The contrast these deserts create raises ethical questions that challenge the current food system.

Ethical Questions

Several ethical questions surround the existence of food deserts and food insecurity, challenging the roots of these phenomena. In particular, racist practices such as redlining that have driven other zip code-based inequalities have also played a significant role in the creation and persistence of food deserts. Medicine also needs help to address the realities of living in a food desert and how best to help patients facing these issues.

The very existence of food deserts and food insecurity poses significant ethical concerns. The United Nations recognizes food as a fundamental human right due to its necessity for survival and well-being (Fanzo). Access to nutritious food as a more specific human right emerges as a focal dimension of this defined human right. While communities often have gas stations and fast food restaurants with plenty of “food,” these communities lack access to healthier options. Many researchers have argued that denying access to food necessary for a healthy lifestyle violates the human right to food (Murrell).

The broader systems that produce and provide food, from farms to commercial supermarkets and in between, are known as food systems (Fanzo). These food systems, while efficient at providing food in theory, are a primary source of food disparity and the creation of food deserts, such as the concentration of healthy food within populated, high-income areas and significant environmental strain as a major greenhouse gas producer and the largest water user. These systems tend only to exacerbate issues with food scarcity, expanding food deserts through profit-driven decisions.

Another central ethical question surrounding food deserts is the role of discriminatory practices in their creation. Food deserts are often subject to a practice known as supermarket redlining. The low average income level of food deserts causes supermarkets and grocery chains to cite failure to turn a profit, leading to the reuse of a term used to describe racial discrimination by banks in financing purchases of homes by African American families. Local leaders in these communities have pointed to the original practice, which often separated families by race and income, as having enabled the creation of “high-income” and “low-income” zones. This fundamental distinction has allowed for “supermarket redlining” to exist in the name of profit. This has led to cases like those in West Oakland, CA, which had no full-service grocery stores until 2019 (Stephens). Food insecurity is resultantly rampant in these areas, leading to adverse health impacts on residents and often disproportionately affecting residents of certain income levels and ethnicities.

Legal researchers have even argued that food deserts are an “antitrust problem” (Leslie). An article in the California Law Review establishes that food deserts are deserts in both the noun and verb sense–deserts with no food and deserted by companies. In addition, the authors also note how supermarkets employed restrictive land covenants to prevent other supermarkets from opening in the location, driving prices up and restricting supply in food deserts, and how antitrust rulings have often incorrectly assumed people have access to cars for transport (something that isn’t the case for many low-income families within these food deserts). These authors then note antitrust law should be used to target the use of these covenants and promote the return of supermarkets to food deserts.