The Built Environment (Part 2): Food Access and Nutrition

Welcome back to the "Built Environment" series. In case you missed part one, you can read it here. In this series we dissect how the various parts of our surrounding infrastructure directly impact our health. Before we dive into today's focus, here is the 'tldr' of part one of the series:

The built environment encompasses our physical infrastructure (buildings and housing, roadways and transportation systems, parks, grocery stores and fresh markets, healthcare etc.). Policies determine how our communities are planned, designed and maintained. Often when we talk about health the conversation centers how much we should exercise and the kind of food we should eat. These factors are typically framed as a matter of personal responsibility. However, what goes unacknowledged is the influence our environment has on our ability to engage in these health promoting behaviors. Our environment determines our access to clean air and water, green spaces, grocery stores and fresh markets, safe housing etc. Therefore, the conversation around health should begin and end with the systems/structures that shape access.

Lets assess what this means from a nutrition and food access perspective. Dietary patterns and subsequent health outcomes are inherently connected to food access. In the US, most people aren't meeting the daily requirement for health promoting foods. This is even more true for ethnic minorities who represent most of the population affected by chronic metabolic diseases like diabetes, hypertension etc. So, what is causing this disparity you might ask? ACCESS.

Mapping Food Access

When it comes to food access, there are a few key terms you should know:

-Food deserts: Areas where residents have limited access to affordable and nutritious food, often due to the absence of nearby supermarkets or grocery stores. These neighborhoods are typically low-income and may rely on convenience stores or fast food outlets, which rarely offer fresh produce or whole foods.

-Food swamps: These are neighborhoods saturated with food options that are energy dense (high calorie minimal nutrients) as opposed to nutrient dense (high nutritional value). Think bodegas, fast food chains etc. These options outnumber places that provide nutritious options.

-Nutrition insecurity: Refers to inconsistent access to nutrient dense foods. Nutrition security is shaped by affordability, cultural relevance and systemic barriers.

-Food Apartheid: Unlike “food desert,” which implies a natural or accidental lack of grocery stores, food apartheid highlights how historical policies, racial segregation, economic disinvestment and zoning laws have deliberately shaped unequal access to nutritious food.

Access to fresh, affordable food is shaped by a complex interplay of urban planning, zoning laws, transportation etc. These factors determine not only where food outlets can exist, but also who can reach them and what kinds of food are available. Here's how each element contributes to food access and how disparities emerge across urban and rural landscapes.

Urban planning is an interdisciplinary field whose key function is to design and manage the development of communities often taking into consideration, economics, governmental goals, land use regulations etc. to address public health, transportation and housing shortages etc. Planners often utilize data to inform long term projects that aim to create communities that are livable, sustainable and conducive to the health of its residents. Urban planning can be funded by local, state or federal revenue, or the private sector. When we compare the state of various communities, there is a stark disparity between the ones that are well developed and maintained and the ones that are neglected and run down. An important question to ask here is, who determines which communities are invested in, what are the considerations that inform this decision and how can we advocate for and initiate reform?

Zoning laws regulate land use and determine what types of business places or buildings can operate in specific areas. Through zoning, commercial areas and residential areas are kept separate. This can be beneficial in terms of reducing noise pollution or even traffic accidents in residential areas. On the contrary, it can create significant barriers to food access. For example, restrictive zoning can limit or even completely prevent grocery stores or farmers markets from opening in residential areas. Flexible zoning on the other hand can provide the opportunity for grocery stores, farmers markets or even community gardens to help mitigate food deserts.

Historically, zoning has been interconnected with racial discrimination. A direct consequence of this is 'redlining' which describes the practice of labeling certain areas as hazardous. This label is often based on race and results in a number of consequences, including banks or insurance companies withholding services from residents of these areas or supermarkets and other fresh food retailers refraining from opening in these areas due to "perceived lack of profitability". Redlining is now illegal but its impact persists today. Redlining is the reason behind the disinvestment of many low income communities and subsequent emergence of food deserts.

Transportation is another factor that determines food access. It is critical for distribution as well as consumer mobility. Consumers who do not own a car rely significantly on public transportation for mobility. In rural areas, grocery stores are typically at a far distance from residential areas. Transportation barriers such as no public transit system or infrequent or unreliable buses can make even nearby stores inaccessible for those without cars. Poor infrastructure and long travel times can also make distribution and access incredibly painful and unsustainable.

Transportation and zoning are central to urban planning as they determine land use (where markets are built/operated) and efficient movement (mobility and access) within a city. Thus, when concerns surrounding food access arise, these are key factors that should be centered in systems analyses and resulting projects/interventions that aim to reduce food insecurity and improve health outcomes.

Nutrition Outcomes and the Built Environment

Dietary patterns and health outcomes are linked to access. Limited access to nutritious food often drives reliance on ultra-processed foods which increases the risk of chronic illnesses such as diabetes, cardiovascular disease etc. Ultra-processed foods are often convenient, shelf stable and cheaper which makes them highly accessible especially in underserved communities with few grocery stores and high food insecurity. Consequently, this narrows the available choices, often excluding fiber rich, nutrient dense options essential for metabolic health.

This dietary pattern fosters the development of metabolic diseases as it tends to be high in sodium, refined carbohydrates and unhealthy fats. Refined carbohydrates impair insulin sensitivity increasing insulin resistance and consequently results in type two diabetes. High sodium and unhealthy fats elevate blood pressure and cholesterol, increasing risk of atherosclerosis, heart attack and stroke. These health outcomes disproportionately affect Black, Hispanic and Indigenous communities compared to their white counterparts. As a nutrition scientist, I often come across scientific articles that list these groups as having high rates of metabolic diseases, increased bodyweight and increased consumption of ultra-processed foods. However, very few of these articles detail the underlying structural and racial inequities that perpetuate these health disparities.

These communities are more likely to live in food desserts often surrounded by fast food outlets and very few grocery stores. As much as we might not want to admit it, structural racism influences zoning laws, supermarket placement and community design (or the lack thereof) which in turn directly contributes to poor health outcomes. To combat these disparities in health, real solutions that target disparities in access are mandatory.

Solutions and Reimagining Food Spaces

Reimagining food spaces is a powerful lever for health equity, chronic disease prevention and community resilience. These changes will require the concerted impact of community based solutions, policy levers for structural change and interdisciplinary collaboration.

Transforming food environments require more than just increasing access, it demands a reimagining of how, where and by whom food is grown, distributed and consumed.

Community-driven initiatives like gardens, mobile markets and urban agriculture can help communities reclaim food sovereignty from the ground up. Community gardens can be used to convert vacant lots into vibrant hubs of nourishment and connection, where neighbors can participate in growing fresh produce, share their cultural foodways and rebuild trust in local food systems.

Mobile markets and food hubs can bring affordable, fresh and culturally relevant foods directly to underserved neighborhoods, often accepting SNAP and WIC benefits to reduce financial and transportation barriers. Meanwhile, urban agriculture, through rooftop farms, hydroponics and school-based gardens can be utilized as nutrition education and community enrichment tools that embed nutrition into daily life.

To ensure the longevity of these initiatives, grassroots innovation must be matched by structural change. Policy levers like zoning reform can dismantle barriers to healthy food retail and urban farming, while reducing the proliferation of fast-food outlets in vulnerable communities. Financial incentives such as subsidies for farmers markets, can shift the economic landscape in favor of health. Equally critical is transportation equity: without reliable transit, even the best food options remain out of reach. Investments in walkable infrastructure, bike lanes and transit routes that connect residents to food outlets are essential for long-term impact.

Interdisciplinary collaboration will need to be at the heart of this transformation. Urban planners, public health professionals, nutrition scientists and community leaders must co-create solutions that reflect both lived experience and scientific evidence. Planners can design neighborhoods that prioritize food access and green space. Public health experts can track dietary trends, evaluate interventions for efficacy and determine areas that require improvement. Nutrition scientists can translate research into culturally relevant guidance and community leaders can ensure that solutions are rooted in trust, dignity and local knowledge. With this level of collaboration, we can build food systems that not only prevent chronic disease but also nourish resilience, equity and joy.

The fact remains that we cannot isolate environmental circumstances or social infrastructure from health outcomes as they are inextricably linked. This link should be a public health priority and the first line of defense when we seek to address health, as it holds the keys to transforming health in scalable and sustainable measures.

In the next blogpost, we will review how our infrastructure promotes or discourages physical activity. Until then, I want you to reflect on this question: What would our food systems look like if they were designed for dignity, not just convenience?