Academia Nuts: Lavonna Lewis

You won’t find Lavonna Lewis at a Trader Joe’s. It’s not because she is morally opposed to food samples, or that she has problem with their extensive supply of fresh fruits and vegetables. In fact, she would probably prefer if most markets had similarly healthy and accessible options.  But when Trader Joe’s officials basically told Lavonna that they weren’t interested in having a Los Angeles store east of La Brea, they lost her patronage.

Trader Joe’s unwillingness to join the larger community may seem insignificant, but their hesitancy to leave West LA encapsulates many of the food policy issues present not only in Southern California, but throughout the country.

It is in food policy that Professor Lewis, a 20 year USC faculty member with a Ph.D in Political Science and a Masters in Public Health, focuses her efforts. She and her team are concerned with expanding access to healthy, affordable food options in neighborhoods where it’s easier to buy a burger than a banana. In public discourse, these areas are referred to as ‘food deserts.’

“Basically, ‘food desert’ is saying that within a walking distance, people don’t have access to quality, affordable, healthy food options, whether that’s fruits and vegetables that they can prepare themselves, or maybe healthier options that might be available in a sit-down restaurant versus a fast food restaurant,” Lewis told me when we sat down for coffee last Friday. “In a food desert, it’s not easy for people to make the healthy choice.”

The USDA’s original definition for food deserts is as follows: “Low-income areas where a significant number or share of residents is far from a supermarket, where ‘“far”’ is more than 1 mile in urban areas and more than 10 miles in rural areas.” The map below shows the regions, highlighted in green, that meet this definition, according to 2010 census data.

It’s easy to understand why proximity to healthy food options is such an important factor in making food purchasing decisions. Especially in low-income areas, where a greater proportion of people need to work many hours at low wages in order to make a living, dragging oneself to the market after a long day can be a tall order. When there’s a McDonald’s right around the corner with cheeseburgers on the dollar menu, it’s no wonder that people often opt for the cheaper, easier, and less healthful option.

But these dietary decisions have consequences. We know that black communities in LA county have significantly higher rates of obesity and diabetes than white neighborhoods, so it should come as no surprise that food deserts are generally concentrated in communities of color. Lack of access to healthful food is a systemic issue, connected with legacies of racism and displacement, disproportionately affecting low-income racial minorities.

“If you think about health from basically before you’re born, prenatal care until end of life care, lack of access [to healthful food] has consequences,” Lewis said. “If certain foods or vitamins are necessary for healthy development, and you don’t get those resources, you’re already at a disadvantage. And without intervention, disadvantage will persist over your lifetime.”

Rising rates of obesity and diabetes have been at the forefront of public health discussions for the past decade. But if our resources are spent on medical care post-diagnosis, we miss the opportunity to address the root causes of the diabetes epidemic.  According to Professor Lewis, “The focus around access to healthy foods is really around this idea of prevention. That’s why people are doing what they call ‘moving upstream.’ So rather than a doctor treating your diabetes, you move further upstream to find out what it is about your community that might put you at greater risk for diabetes and try to arrest that.”

Yet for some reason, while diabetes and obesity have enjoyed the spotlight as part of national awareness campaigns, food justice has remained in obscurity — a concern of policymakers, largely ignored by the public and the media. It’s not a very sexy topic, not very well suited for our reality television election cycle. Furthermore, food access seems like a problem with an easy solution: you don’t have access to fruits and vegetables? Build a grocery store! Easy!

If only it were that simple. An analogy: In the education system, schools are financially rewarded for high performance. Education funding quickly becomes cyclical, because school improvement can usually be tied to increases in funding. The well-performing schools get better, and the poorly-performing schools are never given the chance to improve.

Food access is an analogous problem — residents in a food desert forgo healthy food options (because they aren’t available), and businesses use consumer purchasing decisions as justification for not supplying healthy options. After all, no one would spend on kale! “I know for a fact that the Ralphs down the street (Vermont and Adams) doesn’t make available as many organic fruits and veggies when [USC students] are gone then it does normally,” Lewis said.

But this is fallacious thinking, in education as in food policy. How can you adequately measure demand when supply is limited to fast food restaurants and liquor stores?  The only way to accurately measure interest in healthful food options is to provide them to a community and then study consumption patterns once there is a greater variance in available fresh fruits and vegetables. But even getting fruits and veggies into a community can pose a challenge.

One such obstacle encountered by Professor Lewis in her study of food deserts? Advertising. “What’s being promoted before you ever open the door?” Lewis and her team asked markets and restaurants to understand which items were offered as part of dining specials. “Are they promoting fruits and vegetables or they promoting liquor? Are they promoting the super size entreé, or are they promoting a new salad?”

They found that in low access communities, it was the unhealthy choices that were generally on display. It’s not that these businesses are evil, peddling poison to their friends and neighbors. But businesses, particularly in low-income neighborhoods, are always vulnerable, operating on very thin profit margins. “If I know that I’m in a community where people smoke, then I want people to know I’ve got cheap cigarettes,” Professor Lewis said. It’s the same for food. Because residents of food deserts don’t spend on fresh fruits and vegetables, vendors don’t want to provide them for fear of missing their bottom line. “They’re just kind of reinforcing unhealthy choices.”

For this reason, Lewis will try to meet businesses halfway. She lives in the communities where her research is conducted, and understands the struggle. Her job as a policy maker and community influencer is to “get people to recognize the consequences of continuing to promote bad choices and get them to say, ‘Okay, we will keep one beer ad and then add some healthy options.’”

And it’s not just about altruism. While an appeal to community is one way of getting markets and restaurants to alter their available food options, there is also a strong economic incentive. “We are talking to the people in the community, and they are telling us that if [local businesses] bring something healthier, they are gonna buy it,” Professor Lewis said. “[Consumers] are leaving the community to buy [healthy foods], so it’s like resources are kind of leaking out of the community.”

Working with grocery stores and markets is just one way Lewis and others of the food justice movement are hoping to alleviate low access to quality nutrition. Other important solutions include: farmer’s markets, pop-up markets, community gardens, and store redesigns (e.g. turning a liquor store into a fresh produce market). The key idea is to give people as many ways as possible to make the healthy choice; do enough, and it becomes the easy choice.

While expanding food access is the top priority and ultimate goal of Lewis and her team, there are still important, intermediary steps that they are taking in the meantime. On the local level, this can mean a moratorium on the construction of stand alone fast-food restaurants, like the one enacted in 2008 in South Los Angeles. In recent years, the efficacy of this policy has been questioned, as obesity rates continued to rise. But still, it is a necessary part of improving access to healthful food. It is, of course, not enough to just curtail bad dietary options; they need to be replaced with nutritional alternatives, and without this second part of the equation it should not be surprising that the problem persists. Poor access to healthful food didn’t develop overnight, and it won’t be solved overnight either.

Visibility for the food justice movement, and an increased awareness for the problem is another key step. “Healthcare providers [residing in West LA] who have patients in South LA may have no idea what their patients are going through when they ask them to change their diet,” Lewis told me. “The physician gets frustrated because the patient isn’t following orders, and the patient is frustrated because the physician has no idea what life is like when he leaves his office.” There’s definitely a disconnect between healthcare providers and patients when it comes to dietary changes; educating physicians about the difficulty for many patients in adopting new behaviors can go a long way in improving holistic medical care.

Even more than that, spreading awareness will help dispel the myth that bad choices are made by bad people. “Just telling someone to do something without a real appreciation for their context leaves you to blame people for making bad choices,” Lewis said. “They may be bad choices, but they were the only choices that I had to make, and I will eat, I will not starve.”

And there is the heart of the problem. Why should we care about food policy? It can be difficult for people who have never worried about food access to understand the necessity of making drastic, systemic chances as soon as possible. But the essence of food justice, what makes it an urgent, pressing issue, is the simple fact that we need food to survive. Unlike physical exercise, eating is not a discretionary activity. We all have to eat, and we should all be able to make informed decisions about what we put in our bodies.

I asked Professor Lewis if policy and regulation was the only viable means of solving the problem of food access. “I think when we don’t know what’s going to work, we are very happy letting people try to do things voluntarily, figuring out what works,” she told me. “But if over time we find out something is working better than anything else, you can’t justify not doing it anymore.”