Madam
As a nurse with particular interest in food accessibility and obesity-related disease prevention, I read the Peng and Kaza(Reference Peng and Kaza1) article in the May 2019 edition of Public Health Nutrition with great interest. The article emphasised the impact of the greater built environment and neighbourhood context on food availability and fruit and vegetable purchases in US households. Growing evidence has shown, however, that food environments can no longer be isolated to ‘availability’ alone(Reference He, Tucker and Irwin2–Reference Walkinshaw, Chan and Nadinechan5). The authors briefly addressed related factors apart from availability in their background, but ultimately emphasised regional destination accessibility and neighbourhood destination diversity.
In examining concepts such as destination diversity and street connectivity, the authors disregarded other related concepts to food availability such as affordability, acceptability and accommodation(Reference Walkinshaw, Quinn and Rocha6). Food affordability and food culture are intrinsically tied to food availability(Reference Richardson, Boone-Heinonen and Popkin4,Reference Horning and Fulkerson7) . Isolating the concept of food availability solely to the physical built environment disregards strong socio-economic factors and psychosocial factors in food purchasing behaviours and food environments. Proximity to available stores or presence of convenience stores becomes irrelevant if basic financial means prevent purchases of fruits and vegetables, let alone simply adequate amounts of food. Even when supplementary funds are provided for individuals, such as SNAP benefits, participants struggle to adequately feed themselves and their families by the end of the month or consume adequate fruits and vegetables(Reference Keith-Jennings, Llobrera and Dean8,Reference Zhang, Liu and Rehm9) .
Studying physical built environments and food availability in one context alone further homogenises the concept of food availability. The study by Peng and Kaza(Reference Peng and Kaza1) (2019) examined families above median national household income and predominately White, despite food inaccessibility predominantly affecting low-income households(Reference Richardson, Boone-Heinonen and Popkin4,Reference Loopstra10) . Physical environments in the context of low-income households emphasise different aspects of the food environment like affordability more than availability(Reference Darmon and Drewnowski11). Moreover, ‘supermarket greenlining,’ targeting socio-economically deprived neighbourhoods for new supermarkets, could cause an illusion of increased availability of healthy foods(Reference Cohen12). In reality, these areas only further reduce access to healthy foods, due to prices targeting individuals of higher socio-economic status. This could possibly explain the study’s insignificant association between food store availability and fruit and vegetable expenditures. Thus, examining food accessibility through the context of physically built environments alone easily creates an incomplete picture of the food environment. The physical built environment is undoubtedly important, but factors such as affordability and time poverty should ultimately take precedence over regional destination accessibility or neighbourhood destination diversity.
Acknowledgements
Acknowledgements: Dr. Frances Lewis, University of Washington School of Nursing, ARCS Foundation Fellowship, School of Nursing Troop Scholarship, School of Nursing Fraser Scholarship. Financial support: None. Conflict of interest: None. Authorship: A.P. devised the letter to the editor with critical feedback from Dr Frances Lewis at the University of Washington School of Nursing. Ethics of human subject participation: Not applicable.
