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Accessibility to nutritious, affordable, high-quality food has long been a challenge in low income and rural areas across the US and globally.^1-3 As inflation increased food prices dramatically following the COVID-19 pandemic, the issue of access to healthy food has only increased, and low-income families, the elderly, and children are especially vulnerable to what has become an increasingly pervasive state of food insecurity. Find out what one clinician is doing to help.

What Are Food Deserts?

In the US, a “food desert” has been defined as an area in which a significant portion of the population has limited access to healthy foods; in urban areas, this means living more than a mile from the nearest supermarket, or in rural areas, 10 miles away.⁴ The poverty rate in these communities is 20% or greater, or the median-family income is below or equal to 80% of the statewide median family income.⁴ An estimated 39 million people, or 12.8% of the US population, lived in “low income and low access areas” in 2015.⁴

Living in a food desert can increase the risk of developing diet-related health conditions and chronic diseases such as obesity.⁵ WHO has linked inadequate fruit and vegetable intake to millions of deaths worldwide⁶ while observational studies continue to suggest that higher fruit and vegetable consumption is associated with lower mortality.^7,8

Community Interventions

Local farmers markets can serve as interventions, bringing healthy food options to food deserts, and they are viewed as just one way to begin addressing chronic health problems.⁹ Farmers markets can be purposefully developed in communities with high rates of poverty, communities of color, and/or communities with limited access to healthy foods.⁵ Studies show promising results, with reviews suggesting positive effects of fruit and vegetable intake in the prevention of several chronic diseases, including type 2 diabetes, chronic inflammatory bowel disease, rheumatoid arthritis, chronic obstructive pulmonary disease, asthma, and more.^10,11 In another study, low-income, diabetic shoppers increased their fruit and vegetable intake by 1.6 servings per day using an incentive program based at a farmers market located at a health center.¹²

Jeffrey Geller, MD, a functional medicine–aligned clinician who has been a pioneer in conducting group medical visits, is passionate about delivering care and nutrition to underserved communities. Many people in these communities tend to prioritize “having food” over the “quality of that food,” explained Dr. Geller. As well, due to the nature of food stamp programs, people lean toward purchasing non-perishable foods that will last a long time. This is often at the expense of purchasing produce, which has a shorter shelf life. To help address this access problem, in 1997, Dr. Geller co-created a community garden behind a health center in Lawrence, MA. Later, a nonprofit called Groundwork Lawrence built formal community gardens and open spaces for residents there, helping to bring extra vegetables from farmers markets to the city.

Dr. Geller practices family medicine at the Integrated Center for Group Medical Visits in Lawrence, MA. He is also one of the founding members of Integrative Medicine for the Underserved (IM4US), a nonprofit organization that brings best integrative practices of healing to underserved communities. Here, he reflects on a moment that illustrates the powerful connection between food and community:

“One year, our community gardens were run by our teen empowerment group visit program. There was a boy who at the beginning of the year was insistent that he would never eat a tomato. We grew the vegetables and gave them to other groups so that they could make salsa for chips. Toward the end of the season, all of the other children encouraged him to eat a tomato. He did, and his smile was amazing. He now loves tomatoes,” said Dr. Geller. “Empowerment is trying new things. When I think about all the new things he had to try and do to get to that point of feeling comfortable putting a tomato in his mouth: planting seeds, planning a garden, making supportive friendships, helping others, etc., I realize that something as simple as eating a tomato is really not that simple.”

To be sure, farmers markets like these don’t just offer fresh produce; they work to address the root causes that make it harder for people to eat healthfully, and perhaps most importantly, create a sense of community, well-being, and belonging. Learn more about the functional medicine model or find a functional medicine practitioner near you by following the links below.

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Food Insecurity and Chronic Disease

The Hidden Hunger: Micronutrient Deficiencies

References

1. Nutrition and Food Safety (NFS). The state of food security and nutrition in the world 2024: financing to end hunger, food insecurity and malnutrition in all its forms. World Health Organization. Published July 24, 2024. Accessed October 11, 2024. https://www.who.int/publications/m/item/the-state-of-food-security-and-nutrition-in-the-world-2024
2. Hunger numbers stubbornly high for three consecutive years as global crises deepen: UN report. Joint News Release. World Health Organization. Published July 24, 2024. Accessed October 11, 2024. https://www.who.int/news/item/24-07-2024-hunger-numbers-stubbornly-high-for-three-consecutive-years-as-global-crises-deepen–un-report
3. Rabbitt MP, Reed-Jones M, Hales LJ, Burke MP. Household food security in the United States in 2023(Report No. ERR-337). US Department of Agriculture, Economic Research Service. Published September 2024. Accessed October 11, 2024. https://www.ers.usda.gov/webdocs/publications/109896/err-337.pdf?v=9046.7
4. United States Department of Agriculture Economic Research Service. State-level estimates of low income and low access populations. Updated September 30, 2019. Accessed October 11, 2024. https://www.ers.usda.gov/data-products/food-access-research-atlas/state-level-estimates-of-low-income-and-low-access-populations/
5. Freedman DA, Whiteside YO, Brandt HM, Young V, Friedman DB, Hébert JR. Assessing readiness for establishing a farmers’ market at a community health center. J Community Health. 2012;37(1):80-88. doi:1007/s10900-011-9419-x
6. World Health Organization. Increasing fruit and vegetable consumption to reduce the risk of noncommunicable diseases. Updated August 9, 2023. Accessed October 11, 2024. https://www.who.int/tools/elena/interventions/fruit-vegetables-ncds
7. Wang DD, Li Y, Bhupathiraju SN, et al. Fruit and vegetable intake and mortality: results from 2 prospective cohort studies of US men and women and a meta-analysis of 26 cohort studies. Circulation. 2021;143(17):1642-1654. doi:1161/CIRCULATIONAHA.120.048996
8. Liu W, Hu B, Dehghan M, et al. Fruit, vegetable, and legume intake and the risk of all-cause, cardiovascular, and cancer mortality: a prospective study. Clin Nutr. 2021;40(6):4316-4323. doi:1016/j.clnu.2021.01.016
9. George DR, Kraschnewski JL, Rovniak LS. Public health potential of farmers’ markets on medical center campuses: a case study from Penn State Milton S. Hershey Medical Center. Am J Public Health. 2011;101(12):2226-2232. doi:2105/ajph.2011.300197
10.  Boeing H, Bechtold A, Bub A, et al. Critical review: vegetables and fruit in the prevention of chronic diseases. Eur J Nutr. 2012;51(6):637-663. doi:1007/s00394-012-0380-y
11.  Woodside JV, Nugent AP, Moore RE, McKinley MC. Fruit and vegetable consumption as a preventative strategy for non-communicable diseases. Proc Nutr Soc. 2023;82(2):186-199. doi:1017/S0029665123002161
12.  Freedman DA, Choi SK, Hurley T, Anadu E, Hébert JR. A farmers’ market at a federally qualified health center improves fruit and vegetable intake among low-income diabetics. Prev Med. 2013;56(5):288-292. doi:1016/j.ypmed.2013.01.018