The purpose of this discussion is to offer you the opportunity to debate the issue of food justice and food deserts. Food deserts are significant issues in poorer neighborhoods in the United States. In many of these neighborhoods, the only access to food is through local convenience stores or fast food restaurants. This severely limits the options for the poor to have access to fresh, wholesome food and has been evidenced as a key reason for the obesity epidemic in the United States. This issue is encompassed in the overarching topic of food justice, which also highlights public access to genetically modified or organic foods and the issues of equal access to positive food options in light of public health and social inequality. Prepare and post a response to the following prompt: Read the Hilmers article, Neighborhood Disparities in Access to Healthy Foods and Their Effects on Environmental Justice. Assume that your town is a food desert and you would like to do something about it. Prepare an argument to present to your local town council that outlines an idea to offer healthy food options to your town. Use at least one ethical theory or perspective to support the moral or ethical reasoning for why this program should be implemented. Must be a minimum of 250 words in length. Utilize the reading material and article to support your claims. GOVERNMENT, LAW, ANO PUBLIC HEALTH PRACTICE Neighborhood Disparities in Access to Healthy Foods and Their Effects on Environmental Justice Angela Hilmers, MD, MS, David C. Hilmers, MD, MPH, and Jayna Dave, PhD Environmental justice is concerned with an equitable distribution of environmental burdens. These burdens comprise immediate health hazards as well as subtle inequities, such as limited access to healthy foods. We reviewed the literature on neighborhood disparities in access to fast-food outlets and convenience stores. Low-income neighborhoods offered greater access to food sources that promote unhealthy eating. The distribution of fast-food outlets and convenience stores differed by the racial/ethnic characteristics of the neighborhood. Further research is needed to address the limitations of current studies, identify effective policy actions to achieve environmental justice, and evaluate intervention strategies to promote lifelong healthy eating habits, optimum health, and vibrant communities. {Am J Public Health. 2012;102: 1644-1654. doi:10.2105/AJPH. 2012.300865) ENVIRONMENTAL JUSTICE HAS been defined as fair treatment and meaningful involvement of all people regardless of race, ethnidty, income, national origin, or educational level in the development, implementation, and enforcement of environmental laws, regulations, and poUdes.'*" Fair treatment signifies that "no population, due to policy or economic disempowerment, is forced to bear a disproportionate exposure to and burden of harmful environmental conditions." " P " The concept of environmental justice, which has its roots in the fight against toxic landfills in economically distressed areas, can be similarly applied to the inequitable distribution of unhealthy food sources across socioeconomic and ethnic strata.' The neighborhood environment can help promote and sustain beneficial lifestyle patterns or can contribute to the development of unhealthy behaviors, resulting in chronic health problems among residents.^"'* The higher prevalence of obesity among low-income and minority populations has been related to their limited access to healthy foods^"'® and to a higher density of fast-food outlets and convenience stores where they live.*''^"^' These environmental harriers to healthy living represent a significant challenge to ethnic minorities and underserved populations and violate the principle of fair treatment Several studies have investigated disparities in the distribution of neighborhood vegetati the proximity of residences to playgrounds,^'' and the accessibility of supermarkets and grocery stores,^'''^® but fewer have examined access to fast-food outlets cind convenience stores as a function of neighhorhood racial and socioeconomic demographics. To our knowledge, our review is the first to expand the focus of environmental justicefi-omenvironmental hazards and toxic exposures to issues of the food environment by examining research on socáoeconomic, ethnic, and racial disparities in neighborhood access to fast-food outlets and convenience stores. METHODS We reviewed studies of differences in accessibility of fast-food outlets and convenience stores by the socioeconomic and radal/ ethnic characteristics of neighborhoods. With the assistance of an experienced health science librarian, we conducted searches in the MEDLINE, PubMed, PsycINFO, EBSCO Academic Search Premier, and Scopus databases. Key words were "neighborhood deprivation," "food environment," "food sources," "fastfood restaurants," "convenience stores," "bodegas," "disparity," "inequality," "minorities," "racial/ ethnic segregation," and "sodoeconomic segregation." We induded only original, peer-reviewed studies published in English 1644 1 Government, Law, and Public Health Practice | Peer Reviewed | Hilmers et al. between 2000 and 2011. Comments, editorials, dissertations, conference proceedings, newsletters, and policy statements were excluded. We also excluded studies that focused on methods and measurements, did not examine socioeconomic or racial/ ethnic characteristics of the neighborhood, or used schools as a proxy for neighborhood environment. Our search identified 501 unique citations; after detailed inspection, we selected 24. The primary reasons for exclusion were irrelevant outcomes or comparisons (n = 316), focus on dietary behavior (n = 96), and methodology studies (n = 65). We defined fast-food outlets as take-away or take-out providers, often with a 'drive-thru' service which allows customers to order and pick up food from their cars; but most also have a seating area in which customers can eat the food on the premises (http:// www.merriam-webster.com). Examples of fast-food outlets were fast-food restaurant chains, take-away or carry-out establishments, and small local fast-food businesses. We defined convenience stores as retail stores that sell a combination of gasoline, fast foods, soft drinks, dairy products, beer, dgarettes, publications, grocery items, snacks, and nonfood items American Journal of Public Health | September 2012, Vol 102, No. 9 GOVERNMENT, LAW, AND PUBLIC HEALTH PRACTICE 35 .Ä- J .e- .- .e- CD o •s .s }= g. O i - -. E^ S I I J^ eu '•^ II •a •x= S "^jH LO Q- CJ "O 03 a eu CO •- (O ^ -€ ? I .= 2 i 2 I I •! LTÏ m C_J C_3 _O • & ) o en CD o ^ . 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LO eigh 1 S i •S •63 nco •g. -MO iity a B .E 55 .= s S g. s Îl II to QJ S 1 .1 ^ S ¿S S. o E 1 I S SQ. e s ai 1 "i 1 I t i I ¡2 t •t i S Z I I I ° " i -S 1 g E 5 -E °° S OJ .c -s .a •B 1648 I Government, Law, and Public Health Practice | Peer Reviewed | Hilmers et al. o *"* -g g S -s 1 •a American Journal of Public Health | September 2012, Vol 102, No. 9 GOVERNMENT, LAW, AND PUBLIC HEALTH PRACTICE and have a size less than 5000 square feet"*"'"" £3 I CD ^= E o RESULTS s J i Pf ^ g V s O .= ,ë É Of the 24 studies identified (Table 1), 14 were conducted in the United States^**"*; the remainder took place in Canada, England, Scotland, Australia, and New Zealand.^^"^' Most studies were cross-sectional,^®"^® and 3 had an ecological design.''^"^' Two studies used nationally representative data.^'^''^ The small geographic areas chosen as the units of analysis were a census a census block * a zip code or postal ' a community or '''*^'*^'"'* a territorial authority,*^ or a data zone.''^''*3.49.50 Factors that influenced the choice of units of analysis were the country or area where the study was conducted and the study design. Techniques for identifying fast-food outlet and convenience store locations varied. Most studies used public health agency ts ;- s CO — CD in S g .Ë -s äS a e "h, I 1 S '«5 Oj "D -^ ^" CD t s 1 _ = = -y s ra g o II and area-based geocoding techconducted walking surveys in I 1 -s = .îiï ¿ •- § § CD LD ,= . CID CD CO i .g -i 2 ¿ 1
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