A nationwide study reveals how US neighborhoods became increasingly dominated by restaurants and fast-food outlets, leaving millions with limited access to healthy food retailers, especially outside urban centers.
Study: Changes in Neighborhood Foodscapes From 2003 to 2023 by Area Rurality in the United States. Image Credit: Ministr-84 / Shutterstock
A recent study published in the American Journal of Public Health found that United States (US) census tracts have become increasingly dominated by restaurants and fast-food outlets, while healthy food retailers remain difficult to reach, especially in rural areas and for people relying on public transport.
These findings highlight the need to improve accessibility to grocery stores and other healthy food retailers across the US, particularly for underserved communities.
Diets high in unhealthy foods are associated with excess body weight and higher risks of diet-related chronic diseases. Overweight and obesity can lead to metabolic imbalance and other negative effects on human health.
Such individuals are also more likely to develop chronic diseases such as diabetes, cardiovascular disease, and certain types of cancer. Individual choices and food cultures may influence an individual's dietary habits.
The accessibility and affordability of these foods are also contributing factors. Limited access to healthy food outlets, such as grocery stores, may make it more difficult for people to obtain and consume nutritious foods.
Scientists have investigated socioeconomic disparities in food environments, but the ways in which transportation modes and the coronavirus disease 2019 (COVID-19) pandemic may have altered access to outlets selling healthy foods remain incompletely understood.
US Food Environment Study Design
In the present study, researchers evaluated changes in area-level food environments for US residents between 2003 and 2023. They estimated overall trends and differences between rural and urban regions. They also investigated whether the distance to food places and the accessibility by automobile and public transport influenced these trends.
The team analyzed information on all licensed food retailers from DataAxle over the past 20 years. They estimated the annual percentages of food swamps and food deserts nationally, by rurality, by persistent poverty status, and by state using the modified Retail Food Environment Index (mRFEI).
Food deserts were defined as regions with no healthy food retailers (mRFEI = 0). Food swamps were defined as regions with mainly restaurants and fast-food joints and few or no grocery stores (mRFEI below 33.3). Places with mRFEI ≥ 33.3 were associated with good food environments.
The researchers used the Standard Industrial Classification (SIC) and the North American Industry Classification System (NAICS) to select different types of food businesses. They then identified retailer locations using street addresses. After location mapping, they assigned these businesses to census tracts based on 2010 census boundaries.
The team defined accessibility based on proximity and travel time using three different methods. They assessed access to local food by examining food retailers located within a half-mile of census tract boundaries. They also identified census tracts accessible within 20 minutes by automobile. These locations were up to 10 miles away in urban areas and no farther than 20 miles in rural areas.
Furthermore, they identified retail outlets that people could reach within 20 minutes by public transport, such as buses, ferries, or railways. The researchers derived population-level data from the five-year American Community Survey (ACS) estimates.
Food Swamps Increased After 2003
The team found that food swamps became increasingly common, whereas food deserts remained largely unchanged. The distance-based evaluations indicated that the share of census tracts classified as food swamps rose from 80% to nearly 89% in 2023. The share classified as food deserts, on the other hand, changed negligibly. In fact, food deserts reduced by less than one percentage point over the study period. Across the two decades studied, food deserts were consistently more common in rural communities and among people relying on public transportation.
The researchers believe that the COVID-19 pandemic may have affected the local food environment. The estimates indicate that fewer food outlets were operating nationwide after 2020. From 2020 to 2023, food deserts generally increased, whereas food swamps decreased slightly, coinciding with declines in both healthy and unhealthy food retailers. This partially reversed pre-pandemic trends.
State-level analyses largely mirrored national patterns. By 2023, food deserts were prevalent across the North and Great Plains, with the lowest rates observed in the mid-Atlantic and along the West Coast. Food swamps remained widespread nationwide. According to the study's estimates, approximately 292 million Americans lived in food swamps in 2023.
The American population in food deserts was markedly lower (14 million). This widespread imbalance in access to healthy foods may stem from outlets that offer healthier foods growing more slowly than those that sell unhealthy foods, due to financial and logistical challenges. Warehouse clubs and department stores that sell healthy foods may also be located far from residential areas. Such outlets would also require paid memberships, limiting accessibility.
The authors noted several important caveats. Full-service restaurants were classified as unhealthy retailers, although some may offer healthy meals, because detailed information on food types was unavailable.
The analysis also measured retailers at the census-tract level and counted store locations, which meant it could not fully capture actual shopping behavior, food quality, food affordability, commuting patterns, or access to digital grocery delivery.
Healthy Food Access Policy Priorities
The study's findings suggest that public health agencies, policymakers, and private-sector partners should strengthen partnerships to expand access to grocery stores and other healthy food sources in rural areas. They should also improve access via public transport, such as grocery shuttle services.
Further efforts should evaluate and refine policies that limit the growth of unhealthy food outlets. Researchers should also determine whether online food purchasing and delivery services can help people with limited access to healthy food.
Download your PDF copy by clicking here.
Can AI help build a fairer food system from farm to plate?