Indiana County Health Rankings

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1. Mike Kole says

   February 18, 2010 at 8:25 -05006

   Some county has to be ranked 92. I think the spread between 1-92 is where the useful date lies. Or, if 1-90 are fairly clustered, and 91-92 are way down the chart.

   But, “low access to health foods”? What does that mean, exactly? Not enough boutique farmers markets? Not enough of the funny smelling vitamin stores? Or, maybe, are people there making bad choices? I’m betting it could be that in many locales, you could flood the area with health food stores, organic vegetable stands, and they would dry up for want of traffic.

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2. Doug says

   February 18, 2010 at 8:56 -05006

   According to the explanation page about “built environment”:

   The Food Environment
   Though this field of research is still in its early stages, studies have linked the food environment to consumption of healthy food and overall health outcomes. It is logical that the environment in which people live and engage in on a daily basis has an influence on the types of foods they are likely to purchase and eat.

   A systematic review of the literature on the association between obesity-related health disparities and built environments found strong evidence that access to supermarkets rather than smaller grocery/convenience stores correlates with lower prevalence of overweight, obesity, and hypertension. Conversely, proximity to small grocery or convenience stores was associated with a higher prevalence of these factors.
   . . .
   Measurement Strategies
   . . .
   [T]he County Health Rankings measurement strategy focuses on the size of the outlet and includes grocery stores with more than four employees as well as the number of produce stands or farmers’ markets in a county.
   . . .
   Access to Healthy Foods
   Many studies found an unequal distribution of supermarkets and smaller grocery stores in minority and low-income neighborhoods. While white neighborhoods had more supermarkets, minority and low-income neighborhoods were routinely found to have fewer supermarkets and more small grocery stores.[17-20] In neighborhoods with smaller, non-chain grocery stores, the prices for food are higher than in chain grocery stores and the poor have limited access to chain grocery stores.[21]

   Another study found that obesity prevalence was lower in areas with supermarkets and higher in areas with small grocery stores/fast food restaurants.[19] Similarly, there is evidence that household fruit and vegetable use among Food Stamp Program participants increased when there was easy access to supermarket shopping.[22]

   The food environment is a factor not only in urban neighborhoods but also in rural communities. A study that compared supermarkets and convenience stores in a rural area found that healthy food was much more prevalent at supermarkets and grocery stores compared to convenience stores. Researchers in this study found that low-fat milk, apples, and high-fiber bread were available in 75% to 100% of supermarkets compared with 4% to 29% of convenience stores.[23]

   While the evidence indicates that there are positive health benefits associated with proximity to supermarkets, few studies offer before/after comparisons of adding a healthy food source to the community. Those studies that considered this factor found little to no evidence that the new supermarket prompted increased fruit and vegetable consumption in the community. [24,25]

   Other researchers point out that “neighborhood” is difficult to define. Most people move between multiple environments on a daily basis (e.g., school, work, home, entertainment), making it difficult to pin down a specific “neighborhood” to which they belong. Defining “neighborhood” based on census tracts or zip codes makes assumptions about how people shop and does not include social, cultural, educational, and financial considerations regarding behavior. Instead, it is necessary to consider the relative influences of different environments or neighborhoods as well as how an individual participates in those environments.[26,27] One study reviewed by Lytle found that 14.4% of respondents shopped outside their census tract areas and that low-income people were less likely to buy recommended nutritious food items even though they were available in stores.[17]

   Access to a large supermarket alone may not adequately explain the local food environment. One study analyzed the shelf space devoted to types of food in grocery stores across the country and found that different regions have different mixes of foods in grocery stores.[28] This study also argues against using NAICS codes to classify food outlets because they do not distinguish between supermarkets, medium-sized food stores and small food stores that likely have different mixes of foods

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3. Pila says

   February 18, 2010 at 9:11 -05006

   They are probably looking at whether full-service supermarkets with produce sections, fresh meat and poultry, etc., are conveniently located. Trust me, people doing studies like this don’t care whether the fruits and vegetables are organic or how many supplement stores are around. Don’t ask me what might be meant by convenient, however. My guess is that there are a lot of urban/small city neighborhoods and rural areas in Indiana where there are mostly convenience stores and few supermarkets.

   I looked at the statistics briefly yesterday, and it does seem that relative health corresponds relative wealth and the services that are available–or not available. Obviously, some people want to believe that the residents of Hamilton County are just better, smarter, willing to work harder, and so on.

   Both highly urbanized areas of the state and rural areas are less healthy, at least by the measures used in the report. I think it is interesting that rural areas (and I would include Wayne County in that definition) and urban areas have the same problems.

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4. Pila says

   February 18, 2010 at 9:14 -05006

   Doug beat me to it, and gave a much better and more detailed response. :)

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5. Pila says

   February 18, 2010 at 9:25 -05006

   Although this particular study doesn’t discuss it in depth, I do think that how you “sell” healthy eating and behaviors to people is a huge factor in how receptive they are and whether they will make healthier eating choices. With some people, telling them to eat a diet of mostly whole grains, lightly cooked vegetables, fruits, olive and canola oils, chicken, fish, water, soy milk, tofu, and little to no dairy is going to get you a lot of strange looks and resistance. Tell those same people to do a Daniel Fast–which is basically the same diet but inspired by the Book of Daniel in the Holy Bible–and they will be more willing to eat that way.

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