“You are what you eat.”
The statement has long been circulating in the public consciousness, but it takes on a new meaning through a health equity lens. Public health has become increasingly concerned about the number of people who lack access to sufficient or nutritious food due to physical, social, and economic factors. This can lead to micronutrient deficiencies, and it often manifests as a double burden with overweight and obesity. Food insecurity is growing, and it parallels and intersects with other health equity issues.
If—on a population level—we are what we eat, what does it mean that we eat so inequitably?
It’s a hot question in Arizona, where the connection between food deserts and geological deserts isn’t just in vocabulary. Environmental factors such as drought, a hot and dry climate, soil quality, and the high price of farmland also create challenges to food production in the Southwest—challenges that climate change will continue to exacerbate, as scholar Carissa Taylor explains in her Arizona State University dissertation. The need for public health preparedness and relevant training will continue to increase in years to come, including a need for awareness about how food access and climate change affect people inequitably.
The issues of climate change in the southwestern United States are familiar to people living in its landscapes, where food deserts also stretch for miles across both rural and urban areas. According to the hunger relief organization Feeding America, around 26.8% of children in Arizona face hunger; the state has the third-highest childhood food-insecurity rates in the country. Wide disparities in food security—which follow lines of race, family size, income, education, and other demographics—stem from inequities that not only limit families’ ability to consume safe and nutritious foods, but also increase the risk of chronic, diet-related diseases. Food insecurity varies widely by county, but even in Arizona’s most food-secure county, nearly a quarter of children still experience food insecurity. The effects of hunger and limited access to healthy food can have a multi-generational impact on health—continuing and exacerbating inequities long beyond childhood.
But inequities don’t just contribute to food insecurity; they also make it hard to address. Inequities, along with changing cultural norms of food marketing and school environments, create barriers to having successful obesity prevention programs, as scholars Nicole Larson and Mary Story explain.
Food security initiatives are critical components of public health efforts to achieve health equity. As part of this focus, public health training centers and universities are asking, what role can workforce development play in addressing health equity by transforming food insecurity?
The Region IX – Western Region Public Health Training Center (WRPHTC), based in Tucson, AZ, works to address the intersections of nutrition, physical activity, and obesity with health equity and social determinants of health. WRPHTC develops trainings and webinars for public health workers to better understand the knowledge, skills, and tools that can be used to strengthen community food security and reduce health inequities.
During the past two years, the WRPHTC has provided several trainings for public health professionals on food security. The trainings cover topics like how to better use and evaluate food assistance programs such as SNAP-Ed, as well as programs that focus on people experiencing homelessness and people who have recently arrived as refugees. These 30–40-minute targeted mini-courses provide information to help programs support low-income and disenfranchised families in increasing food security.
WRPHTC’s approach to continuing education is grounded in food justice and an international understanding of human rights. In 2004, Kerstin Mechlem, an officer of the Food and Agriculture Organization of the United Nations, defined a “right-to-food” approach to food security, asserting the human right of people to be able to feed themselves in dignity. Moreover, the World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Food access is integral to that well-being.
Food justice, WRPHTC asserts, would ensure that everyone in a population has continual access to—and positive experiences obtaining—healthy, safe, and affordable food. To achieve this means providing not just programs that respond to hunger and food insecurity, but also programs to prevent these problems. WRPHTC’s trainings address both types of programs.
Working in partnership with communities on such programs is integral to an equity- and justice-driven approach. To that end, the WRPHTC has also developed a series of three courses that focus on how health departments can work with community members to enhance and use local food systems to improve food security and nutritional status, enhance local culture, and integrate local foods into the healthcare systems, as well as to improve the economic situations of families and communities.
“Improving Community Food Security Through Community and School Gardens” identifies the public health benefits of community and school gardens, explains what indicators to use when evaluating such programs, and describes how to develop a comprehensive plan for zoning and certifying school gardens.
“Increasing Local Food in Hospitals and Clinics for Health and Nutrition” focuses on ways to increase local food in hospitals and clinics, an approach that not only provides healthier food in a health-focused setting, but also reflects the kind of systems change necessary for health equity. The course provides guidelines for food safety when using fresh produce, offers strategies for procuring local food, and describes how healthcare systems can use mechanisms like food prescriptions to enable low-income community members to gain maximum access to fresh and local food.
A third course (not yet available) will offer an overview of how health departments and workers can help strengthen Native food sovereignty through healthy diets and local food sources, for the purpose of improving Native health and preserving Native cultures. The course includes skills for developing similar programs in other regions.
WRPHTC is currently working with the HRSA-funded Southwest Telehealth Recourse Center to provide a webinar series that highlights successful nutrition programs in Native American and Pacific Island communities. These webinars focus on the Hualapai community programs, a wellness camp for children and adolescents, a tribal diabetes program, and a multi-island intervention for young children in the Pacific Islands.
With all these trainings, WRPHTC seeks to provide public health professionals the tools they need to expand and promote justice-driven food production and food access in communities most affected by food insecurity. Continuing education, WRPHTC hopes, can spark ideas for program implementation and can change inequitable food systems through public health practice.
Lubna Govindarajan, MPH, Senior Program Coordinator, Region IX – Western Region Public Health Training Center
Deborah Gardner, MPH, MFA, Project Manager, Northwest Center for Public Health Practice, Region X – Northwest Public Health Training Center