Public Health Consequences
of Food Deserts
May 24, 2011
Karyl T Rattay, MD, MS
Director
Division of Public Health
Obesity in U.S. Children:
Tripled Since 1970s
Estimates for Delaware
Prevalence of Child Overweight and Obesity in
Delaware, 2006 & 2008
100%
90%
% of Youth Age 2 - 17
80%
70%
Overweight
60%
Obese
50%
40%
30%
21%
24%
17%
17%
20%
10%
0%
2006
By Year
2008
Source: Nemours Health and Preven5on Services, Delaware Survey of Children’s Health, 2006 and 2008; published in Health Affairs, March 2010, 29:3. Source: Nemours Health and Prevention Services, 2008.
Obesity among Delaware Adults
Summary of the Problem
•  Overweight and obesity are increasing rapidly among children, youth and adults in the US •  Increases are found in all regions of the country, urban/rural, both sexes, all ethnic groups, rich and poor •  But great dispariCes exist Consequences of obesity in
children and adolescents
•  DiscriminaCon •  Anxiety •  Persistence into adulthood •  Asthma •  Abnormal cholesterol •  Sleep problems •  High Blood Pressure •  Earlier maturaCon •  Type 2 diabetes •  ReproducCve problems •  Liver and Gallbladder Disease •  Bone complicaCons •  Depression Prevalence of Diagnosed Diabetes in the United States
Diagnosed cases (1960-1998) and Projected Diagnosed cases (2000-2050)
30
People (millions)
25
20
Diagnosed cases
15
10
5
Projected diagnosed cases
0
Year
Data for 1960-1998 from NHIS, NCHS, CDC
Projected data for 2000-2050 from BRFSS
Diabetes Prevalence Trend Among Adults
in DE and US 2000-2010
50%
45%
Percent of Adults 18 +
40%
35%
% DE
30%
% US
25%
20%
15%
10%
5%
0%
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
% DE
6.4%
7.1%
7.1%
7.7%
7.0%
8.5%
8.1%
8.7%
8.3%
8.1%
8.7%
% US
6.1%
6.5%
6.7%
7.1%
7.0%
7.3%
7.5%
8.0%
8.2%
8.3%
Year
Source: Delaware Health and Social Services, Division of Public Health, Behavioral Risk Factor Survey (BRFSS), 2000-2010.
Promo%ng health lifestyles The new Social Norm? Another Social Norm
Safety is a concern
Sugar and fat: cheap and abundant Our food environment Food environment for many Fast food is cheap and easy Do food deserts exist?
Food deserts exist in the United States,
where area-level deprivation compounds
individual disadvantage
  Evidence for the existence of food
deserts in other high-income nations is
weak.

Source: U.S. Centers for Disease Control and Prevention (CDC), “A Systematic Review
of Food Deserts, 1966-2007,” Preventing Chronic Disease, July 2008:08_0163.
CDC 2011 State Indicator Report:
Children’s Food Environment
•  mRFEI = Modified Retail Food Environment Index: a measure of the
proportion of retailers that typically sell healthy foods within a state.
•  The second column (ICS) shows the index in impoverished census tracts.
Source: U.S. Centers for Disease Control and Prevention (CDC), 2011 Children’s Food Environment State Indicator Report.
http://www.cdc.gov/obesity/downloads/ChildrensFoodEnvironment.pdf
Is there a connection between
food deserts and health?
Increased access to supermarkets is associated with:
  Lower prevalence of overweight and obesity:
  Improved fruit and vegetable consumption, and
  Better diet quality among African Americans, lowincome households, and pregnant women.
In contrast, increased access to convenience stores is
associated with increased risk of obesity.
Source: U.S. Centers for Disease Control and Prevention (CDC), “A Systematic Review
of Food Deserts, 1966-2007,” Preventing Chronic Disease, July 2008:08_0163.
An April 2008 California study found that:
• People who live near an abundance of fast-food restaurants and
convenience stores compared to grocery stores and fresh produce
vendors, have a significantly higher prevalence of obesity and
diabetes;
• The highest rates of obesity and diabetes are among people who
live in lower-income communities and have worse food
Environments;
• For people living in lower-income and higher-income communities
alike, the higher the ratio of fast-food restaurants and convenience
stores to grocery stores and produce vendors near home, the
higher the prevalence of obesity and diabetes.
-- Susan Babey, et al, “Designed for Disease: The Link Between Local Food
Environments and Obesity and Diabetes,” eScholarship. University of California, UCLA
Center for Health Policy Research, April 2008.
Harnessing the Power of Supermarkets
to Help Reverse Childhood Obesity
Children’s Food Environment State
Indicator Report, 2011 CDC
Potential Actions
  Provide incentives for small food store owners in underserved areas to
carry healthier, affordable food items (e.g. tax breaks/credits, loans,
and grants to purchase equipment to store produce and fat free/low fat
dairy; or facilitate linkages to wholesale distributors).
  Create incentive programs to attract supermarkets and grocery stores
to underserved neighborhoods (e.g., tax breaks/credits, loans, and
grants to cover start-up and investment costs; economic development
programs; supportive zoning, negotiation assistance).
  Target public transportation and public safety efforts to ensure
community residents can access healthy food retailers easily and
affordably.
  Promote farmers’ markets, farm stands, mobile markets, and
community gardens as venues for healthy foods.
  Support restaurant programs that offer and promote healthier food
options.
Division of Public Health Priorities
I.
II.
III.
IV.
Promoting Healthy Lifestyles
Promoting Health Equity
Health Reform
Organizational Development
Social ecological model
Individual RelaConship InsCtuConal Community Societal Delaware Public Health
System
Police UniversiCes Home Health Community Centers MCOs Churches Health Department CorrecCons Parks Schools Doctors Elected Officials Hospitals Mass Transit Nursing Homes Philanthropist Environmental Health Civic Groups Urban Planning CHCs Tribal Health Laboratory FaciliCes Drug Treatment Mental Health Employers Economic Development Fire What is currently going
on in Delaware?
• Governors council on Health Promotion
and Disease Prevention
• HeAL Coalition
• Sussex Child Health Promotion Coalition
• Healthy Kids Network in NCC
• Kent county/Dover conversations
For more information
Contact me at:
Dr. Karyl Rattay
Delaware Division of Public Health
302-744-4700
Karyl.Rattay@state.de.us
DELAWARE HEALTH AND SOCIAL SERVICES
Division of Public Health