Introduction 1092 I. The Food Access Narrative 1093 A. Third Way Politics and Food Access 1094 B. The Emergence of Food Access in the United States 1097 C. Municipal Politics and Food Access 1099 D. Food Access and the "Obesity Epidemic" 1100 II. Food Access Policies 1101 A. The Retail Initiative 1102 B. State and Local Fresh Food Financing Initiatives 1102 C. Federal Healthy Food Financing Initiative 1103 D. Advocacy, Philanthropic, and Research Support 1103 III. Limitations of Retail Food Access Policies 1106 IV. The Persistence of Retail Food Access Policies 1108 A. Self-Promotion by Food Retailers 1109 B. Political Appeal of Supermarket Development 1112 C. Analytical Weaknesses 1113 V. Upstream Alternatives 1116 A. Increasing the Minimum Wage 1117 B. Strengthening Labor Protections 1118 C. Expanding the Welfare State 1118 D. Protecting and Expanding SNAP 1119 E. Protecting and Expanding Universal Free School Lunch 1119 Conclusion 1120 INTRODUCTION
In recent years, policymakers, nongovernmental organizations, and activists have supported policies to eliminate disparities in access to healthy food and, by doing so, reduce diet-related chronic diseases. These efforts have involved a wide range of interventions, from the creation of new farmers' markets to programs encouraging convenience stores to sell fresh produce. One of the most prominent food access interventions uses incentives to lure supermarkets to so-called "food deserts," communities deemed to have insufficient full-service food retail. (1) Federal, state, and municipal governments have invested hundreds of millions of dollars to subsidize supermarket development through such programs. (2) However, research has shown that merely expanding access to food retail has no appreciable effect on shopping patterns, food choices, health, obesity, or diet-related diseases. (3) Support for these interventions has nonetheless continued to grow--obscuring underlying issues and detracting from more effective strategies.
This Article examines the emergence of food access as a policy issue, current approaches to increasing food access, and possible alternatives. Part I discusses the development of the current food access narrative, focusing on its appeal to policymakers, urban planners, and public health officials. Part II describes policies to increase access to food retail. Part III reviews research on the relationship between food retail and health outcomes. Part IV examines why increasing food access persists as a policy goal despite its demonstrated failure to reduce health inequities. Finally, Part V proposes alternative strategies for reducing economic and health disparities within food systems.
THE FOOD ACCESS NARRATIVE
The concept of food access was originally applied to dynamics within developing countries with severely malnourished populations. (4) It was meant to reorient anti-hunger efforts away from a simplistic focus on food availability--the physical supply of food--toward one that also considered the ability of people to secure, or access, that food. (5) By the late 1970s, recognizing that the Green Revolution failed to end famines and malnourishment despite increasing agricultural yields, (6) food security scholars and practitioners increasingly emphasized the need to match food availability with food access. (7) Economist and philosopher Amartya Sen popularized the concept of food access in the early 1980s, demonstrating that famines were not the result of insufficient food availability, but rather of policies dictating how people acquired and controlled food, which often deprived the poor of the means to access otherwise plentiful food supplies. (8) Conventional forms of food assistance, which focused on distributing surplus food to impoverished countries, were challenged for perpetuating dependency on donor countries. (9) A 1986 World Bank report on food security in developing countries summarized the new conventional wisdom:
The world has ample food. The growth of global food production has been faster than the unprecedented population growth of the past forty years.... Yet many poor countries and hundreds of millions of poor people do not share in this abundance. They suffer from a lack of food security, caused mainly by a lack of purchasing power. (10) The report defined "food security" as "access by all people at all times to enough food for an active, healthy life" and "food insecurity" as "the lack of access to enough food." (11)
Third Way Politics and Food Access
By the early 1990s, policymakers and social movements in the Global North began to focus on food access within their own countries. Tony Blair's government in the United Kingdom played a critical role in shaping discourse on food access in Europe and North America by emphasizing the availability of conventional food retailers to the exclusion of other factors. "Improved access" quickly became defined as "improved access to food retail"--despite the emergence of social movements that sought to address food disparities in a more comprehensive way. (12) Food insecurity in advanced economies thus became framed as a market failure that could be addressed, it was believed, through incentives for, and private-public partnerships with, food retailers. (13) This narrative proved particularly attractive to municipal policymakers, who sought to entice investors back into capital-starved cities, and public health officials, who were eager to identify environmental factors in the emerging obesity "epidemic." The concept of food access, which Sen had used to explain that poverty and property entitlements were the root causes of food insecurity, had, by the late 1990s, been recast in such a way so as to obscure those very issues.
Tony Blair won a commanding majority in the United Kingdom's 1997 general election, bringing Labour to power for the first time in eighteen years. Like Bill Clinton, his ideological counterpart in the United States, Blair rejected wealth redistribution, government intervention in markets, and increased public spending as outmoded ideological solutions. (14) Branding his politics as the "Third Way"--between conservative Tories and the "hard left"--Blair portrayed himself as a pragmatist capable of achieving progressive outcomes through private sector growth, public-private partnerships, and policies that encouraged individual responsibility and opportunity. (15) "What counts," Blair emphasized during the election, is not "outdated ideology," but "what works." (16)
Blair had seized on the growing health divide between the rich and poor as a campaign issue and promised to make reducing health inequalities a central goal of his new government. (17) Blair appointed Tessa Jowell as his public health minister and established an Independent Inquiry into Inequalities in Health led by the National Health Services' former chief medical officer, Sir Donald Acheson. (18) Both Jowell and the Acheson Inquiry identified the proliferation of so-called "food deserts," communities with insufficient healthy food retail, as a major problem and advocated for improving food access as the solution. (19) While the phrase "food desert" was first used in the early 1990s by public housing residents in Scotland, (20) the term was included in a U.K. government report published in 1995, and the new Labour government popularized it, warning that food deserts were a "real problem" that gave rise to "virtually every major illness." (21) The British media repeated such claims, often uncritically, (22) while funding for such research increased, resulting in a number of studies purporting, at least initially, to link limited food access with poor diet and health outcomes. (23)
Food deserts appeared to be a problem perfectly suited to Blair's Third Way approach. By working with the private sector to expand food retail options, Labour promised a win-win for businesses and low-income residents. "It's the Third Way applied to shopping," as one advocate told The Guardian in 1999, describing a pilot project to bring locally-owned corner stores to food deserts. (24) While the corner store pilot program garnered positive press, supermarkets were the main beneficiaries of the push to expand food retail options. In late 1999, for example, large grocery chain Tesco announced a partnership with Blair's "New Deal" welfare to work program to create two thousand jobs by building new stores in food deserts, (25) which became part of Tesco's broader strategy to expand in low-income and depressed areas through "regeneration partnerships" with local organizations and authorities. (26) Tesco's promise to revitalize food deserts helped propel its rapid growth: between 1990 and 2005 its market share in the United Kingdom nearly doubled, jumping from sixteen to thirty percent. (27)
The Emergence of Food Access in the United States
In the 1990s, researchers and policymakers in the United States increasingly focused on the ability of individuals to purchase food through conventional distribution channels. (28) Although activist groups had addressed hunger and malnourishment for decades, (29) advocates in the United States increased their efforts to improve food access. Government cuts to welfare and food assistance programs, as well as economic restructuring, had rapidly increased food insecurity. (30) The rise in food insecure populations consequently overwhelmed the nation's emergency food system. (31) At the same time, the migration of supermarkets and grocery stores away from low-income neighborhoods often made acquiring affordable food difficult for the urban poor. (32) Newly emerging social movements, including the community food security and environmental justice movements, integrated the concept of food access into their own agendas and activism. (33) In reports, academic articles, and advocacy materials, members of these movements broadened the notion to encompass equity and the entire food...