Food Landscapes and Public Health: Implications for Business and Society

The principle of subsidiarity within Catholic Social Thought emphasizes that “higher entities should not replace smaller entities in fulfilling their tasks, unless the smaller entities are unable to do so.” The emerging phenomenon known as Social Determinants of Healthcare (SDOH) examines the relationship between social context and public health outcomes, citing growing evidence that one’s “zip code may be more important than genetic code” (Beaton, 2018) in determining health outcomes. According to BlueCross/BlueShield, some 60 percent of our health is driven by social determinants – the social and environmental factors in our communities that can lead to “deserts,” with little access to healthcare services, nutritious food, fitness centers and transportation (Serota, 2018). The SDOH philosophy eschews an emphasis on expensive medical treatments once individuals get sick in favor of spending on societal support programs that keep us healthy and prevent sickness in the first place (Butler, 2016). The United States spends just 56 cents on social factors for every dollar spent on healthcare. The average for the Organization of Economically Developed Countries (OECD) is $1.70 spent on social factors for every dollar spent on healthcare (Cattrell, 2018). The purpose of this research project is twofold. First, we investigate empirically the relationships between food landscapes and population health. Next, we consider the implications of our findings for business and society in light of the principle of subsidiarity. To address our first purpose we examine 46 neighborhoods in the city of Philadelphia which is among the poorest large cities in the United States. The food landscape of each community is audited and categorized along several dimensions, including the number and diversity of food store formats, the presence of supermarkets and the availability of healthy food options such as fresh fruits and vegetables. Accessibility, availability, and product mix impact a community and its food landscape. Prior studies done in other parts of the United States and around the world have examined some of these factors that make up a community’s food landscape. This study takes a comprehensive look at the factors - supermarket accessibility, food store mix, availability of produce - in combination. In addition, this study takes the further step of assessing the relationships between these factors that define a community’s access to healthy foods and a key measure of the health of the community - rates of obesity- while controlling for variables such as age, income and education. This study design will test the premise of Social Determinants of Healthcare (SDOH) that social context correlates with public health outcomes. Specifically, our research question will determine the relationships, if any, between the food landscapes of the 46 neighborhoods and the prevalence of obesity in those neighborhoods while controlling for variables such as age, access to healthcare providers, education and income. The prevalence of obesity within a neighborhood is hypothesized to be positively associated with the number of food retailers selling little or no produce. In other words, obesity rates are expected to be higher in food landscapes categorized by large numbers of stores selling energy-dense processed foods but little or no fruits and vegetables. The second purpose of our research is to consider the implications of our findings for business and government in light of the principle of subsidiarity and the “food justice” movement. What obligations, if any, do food marketers have to provide access to healthy foods in low income neighborhoods? Likewise, what is the role of government in addressing unhealthy food landscapes? And what level of government is best situated to address food landscapes at the local level?