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Creating Healthy Communities / Increasing Food Access and Affordability

Increasing Food Access and Affordability2025-07-09T09:33:14-07:00

Access to healthy, safe, affordable food is important for a nutritious diet and good health1

Access to affordable healthy food promotes healthy eating patterns and is crucial to reducing food insecurity, reducing hunger, and improving health.1,2 People experiencing food insecurity have limited, uncertain, or inconsistent access to adequate food that supports good health.  Further, low-income households, communities of color, immigrants, people living in rural areas, and people living with disabilities experience food insecurity at disproportionate rates.  Consumption of healthy foods — like fruits, vegetables, and whole grains —reduces risk for chronic diseases and can improve health; while consuming unhealthy foods — like foods high in saturated fat and added sugars —increase the risk for obesity, heart disease, type 2 diabetes, and other health problems.  In lower income neighborhoods there are fewer large chain supermarkets and grocery stores with affordable fresh fruits and vegetables, but convenience stores and small markets with overpriced fruits and vegetables are prevalent.  People with low incomes living in food deserts — areas with few options for securing affordable and healthy foods— are often reliant on foods that are convenient to access but low in nutrients, which increases the likelihood of experience chronic health conditions.3,4

Progress in increasing food access and affordability is being tracked using two indicators. The first indicator tracks the percent of adults with a low income (under 200 percent of the federal poverty level (FPL)) who reported that they were not able to afford enough food. The second indicator tracks the percent of healthier food retailers available in California, as defined by the modified retail food environment index (mRFEI).

Food Insecurity

In 2022 (baseline year), 44% of lower income (< 200% FPL) California adults 18 years or older reported they were not able to afford enough food. The most recent data available (2022) show 44.0% of lower income adults were not able to afford enough food.  We hope to reach a target of 34.3.% or lower by 2034.

More Data about Food Insecurity

Baseline

44.0%

Current Rate

44.0%

Target

34.3%

Access to Healthy Food

In 2022 (baseline year), the percent of healthier food retailers available in California, as defined by the modified retail food environment index (mRFEI), was 20.8%.  The most recent data available showed a score of 20.8% (2022). We hope to reach a target of mRFEI score of 24.3% or greater by 2034.

More Data about Access to Healthy Food

Baseline

20.8%

Current Rate

20.8%

Target

24.3%

Indicator Highlights

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Skid Row Marketplace

The Skid Row Marketplace is part of a food and wellness collaborative that brings Skid Row residents and food justice allies together to improve the community’s food system with nutrition education, anti-hunger policy, and community gardening initiatives. It is facilitated by the Los Angeles Community Action Network (LA CAN) that serves the Skid Row and other under-served communities across Downtown and South Los Angeles. LA CAN takes a holistic approach to health problems that afflict residents experiencing homelessness and low-income residents of Skid Row due to a lack of sufficient access to health care, nutritious food, and quality, safe housing conditions. Skid Row has the largest concentration of low-income housing in the country and also has the largest concentration of unhoused residents living in street encampments in the country. 5 Read more »

No Markets and Higher Prices Impact Diets

One study found that residents with no supermarkets near their homes were 25-46% less likely to have a healthy diet, and a more recent study found that large differences in price between healthy and unhealthy food play a role in the ability to maintain a healthy diet.6,7

Unhealthy Ads Persist During Children’s Television Programming

Food ads on television make up 50 percent of all the ad time on children’s shows.  The percent of ads for unhealthy food decreased from 2013 to 2022 following changes in the voluntary industry self-regulatory Children’s Food and Beverage Advertising Initiative (CFBAI). However, the majority (51%-52%) of CFBAI-member food and beverage advertisements on children’s programming continued to advertise unhealthy foods, with African American or Black children being exposed to more food-related television advertisements than White children. 8,9

Two in Five Can Not Afford Enough Food

More than two in five adults in California report they cannot afford enough food.  While nearly four in five adults report fresh fruit and vegetables are always available in their neighborhoods, of those reporting both availability and regularly consumption of fresh fruit and vegetables, about 1 in 5 reports that they are only sometimes (17.0 percent), or never (1.4 percent) affordable. 10, 11, 12

Retail environments plays a critical role in our health. They not only impact the physical health of the people who visit them, but also the economic well-being of neighborhoods.  Efforts to make healthy affordable food more accessible in lower income neighborhoods with less healthy retail environments can help prevent chronic disease in these communities. 11

Data Snapshot

Socioeconomic disparities in food access are persistent both nationally and statewide.  In California, a study found fresh produce is more expensive in low-income neighborhoods and that convenience stores offer lower-quality produce, at more expensive prices, than other stores.13,14

In California, 44% of low-income adults (earning less than 200% of the federal poverty level) experienced food insecurity in 2022, up from 35.8% in 2020

Similarly, in California among those with a four-year degree or higher, 35.0% were experiencing food insecurity in 2022, compared to 49.3% of those with less than a high school education.

Disparities in food security between racial and ethnic groups, as well as people living rural and urban areas, persisted in California.

In 2022, adults in California who identified as Two or More Races and Black or African American had the highest rates of food insecurity; compared with Whites and Asians who had the lowest rates.15,16

In 2022, more adults in California living in rural areas experienced food insecurity compared with those living in suburban and urban areas.

After several years of decreasing in California, food insecurity increased in 2022 due the ongoing impact of the COVID-19 pandemic on communities and families.15

In California, the percentage of adults experiencing food insecurity decreased overall from 43.3% in 2015 to 35.8% in 2020, then increased starkly to 44.0% in 2022.

Access to healthy food environments in California increased overall from 17.1% in 2017* to 20.8% in 2022.* – Note – the data source for food retail outlets changed between 2017 and 2022. 

Percent of Adults Reporting Food Insecurity



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Percent of Healthier Food Retailers Available in California, by County



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Indicator: Percent of Adults Reporting Food Insecurity

Indicator Description: This indicator consists of the percentage of adults 18 years or older with incomes below 200% FPL reporting they experienced food insecurity with or without hunger. The data are from the California Health Interview Survey (CHIS), an annual population-based, omnibus health survey of California. It is the largest telephone survey in California and the largest state health survey in the country. Beginning in 2019 CHIS began using web and telephone surveys. Prior to 2019, all surveys were conducted by phone. Note that this indicator uses weighted data. The CHIS is conducted by the UCLA Center for Health Policy Research.

Data Limitations: Asked of California’s residential population (adults, teens, and children), administered in English, Spanish, Chinese, Korean, Tagalog, and Vietnamese. Does not include those living in group quarters or homeless persons.

Indicator Source: California Health Interview Survey (CHIS)

Data Sharing Agreement: Researchers can access a variety of publicly available CHIS data files and web tools. These CHIS data products include downloadable data sets and easy-to-read documents. In addition, local county health departments can request data files specific to their county. However, researchers can apply to analyze confidential CHIS data, data sensitive variables and/or geo-coded data through the CHIS Data Access Center (DAC). Access to confidential CHIS data requires a research application, review, and approval.

Indicator Calculation Methodology: The indicator consists of the percentage of respondents reporting incomes under 200% of the Federal Poverty Level (FPL) who answered “Often True” or “Sometimes True” in  to the prompt ‘The food that {I/we} bought just didn’t last, and {I/we} didn’t have money to get more” or  “{I/We} couldn’t afford to eat balanced meals.“  or answered “Yes” to the prompt “In the last 12 months, did you or other adults in your household ever cut the size of your meals or skip meals because there wasn’t enough money for food?” to determine if they were experiencing food insecurity.  Hunger was determined from those who answered “Yes” in response to the prompt “In the last 12 months, did you ever eat less than you felt you should because there wasn’t enough money to buy food?” or the prompt “In the last 12 months, were you ever hungry but didn’t eat because you couldn’t afford enough food?” More information is available here: https://healthpolicy.ucla.edu/our-work/california-health-interview-survey-chis/chis-design-and-methods

Data Collection Methodology: https://healthpolicy.ucla.edu/our-work/california-health-interview-survey-chis/chis-design-and-methods/chis-methodology-reports-repository

Program URL Link: https://www.cdph.ca.gov/Programs/CFH/Pages/Hunger,-Nutrition,-and-Health.aspx

Reporting Cycle: Annual (June)

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Indicator: Percent of all food retailers that are healthier food retailers.

Indicator Description: The modified Retail Food Environment Index (mRFEI) is a way of measuring the number of healthy and less healthy food retailers in an area using a single number expressed as a percent of healthy food retailers out of all food retailers. A mRFEI score of zero (0.00%) indicates that no healthy food retailers (supermarkets, large grocery stores, produce stores or supercenters) are in the area, and generally indicates the occurrence of a food desert. Among mRFEI scores greater than zero (0.00%), lower scores correspond with the concept of food swamps.

Data Limitations: The Modified Retail Food Environment Index (mRFEI) is an indirect measure of the concept of a food desert. Traditionally, food deserts have been defined using additional criteria including poverty rate and distance from healthy food retailers. For instance, the USDA uses criteria of a low-income tract with at least 500 people, or 33 percent of the population, living more than 1 mile (urban areas) or more than 10 miles (rural areas) from the nearest supermarket, supercenter, or large grocery store).

Indicator Source(s):

Source (Retailer Data): 2022 ESRI Business Analyst (Data-Axle):

Variables:
North American Industry Classification Codes (NAICS):
Healthy food retailers include supermarkets and larger grocery stores (445110), fruit and vegetable markets (445230) and warehouse clubs (452910). *Note – Retailers in NAICS 445110 were identified as healthy if they had a sales volume higher than one million dollars.  Less healthy food retailers included: fast food restaurants (722513), convenience stores (445120) and small grocery stores (445110).

Note:  For our calculations only stores with NCAIS 445110 with a sales volume greater than $1 Million were classified as healthy; which departs from the previous methodology of classifying either NCAISS 445110 stores with more than 10 employees or with a sales volume greater than $1M as healthy; and departs from the Centers for Disease Control and Prevention (CDC) methodology of classifying either NCAIS 445110 stores with 3 or fewer employees as unhealthy. The primary data source for obtaining NCIAS codes and other food retailer data used to calculate mRFEI scores changed between 2017 and 2022, from Dun & Bradstreet to ESRI ArcGIS Business Analyst (via Data Axle business data).

Source (Population, Disability, Poverty, SNAP Recipient): 2021 American Community Survey 5 Year Estimates, US Census Bureau

Variables:
Population (variable B01001_001); Disability (variables B18135_003; B18135_014, B18135_025); Poverty (variable B17001_002); and Supplemental Nutrition Assistance Program (SNAP) allocation (variable B99221_001).

Note: Disability was calculated by combining American Community Survey estimates for ages under 19, 19 to 65, and over 65 (variables B18135_003, B18135_014, B18135_025, respectively).

Data Sharing Agreement:  N/A

Indicator Calculation Methodology:

Modified Retail Food Environment Index (mRFEI) scores = ((number of healthy retailers) / (number of less healthy + healthy retailers)) * 100.

Methodology developed by the Centers for Disease Control and Prevention ( available here: https://www.cdc.gov/obesity/downloads/census-tract-level-state-maps-mrfei_TAG508.pdf ) was used to calculate the modified retail food environment index, with some modifications.

Data Collection Methodology: https://doc.arcgis.com/en/esri-demographics/latest/reference/data-axle.htm ; https://storymaps.arcgis.com/stories/d13b635ab9ac44759e99eb52646877f8

Program URL Link: https://www.cdph.ca.gov/Programs/OHE/Pages/HCI-Search.aspx# ; https://www.cdph.ca.gov/Programs/OHE/Pages/HCI-RetailFood.aspx

Reporting Cycle:  Annual

1. U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2030. (2024). Nutrition and Healthy Eating. Retrieved February 4th, 2025, from https://health.gov/healthypeople/objectives-and-data/browse-objectives/nutrition-and-healthy-eating

2. U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2020). Dietary Guidelines for Americans, 2020-2025. Retrieved February 4th, 2025, from https://www.dietaryguidelines.gov/

3. The Annie E. Casey Foundation. (Updated 2024, August 4 | Posted 2021, February 13). Food Deserts in the United States [Web log post]. Retrieved February 4th, 2025, from https://www.aecf.org/blog/exploring-americas-food-deserts.

4. U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2030. (2024). Access to Foods That Support Healthy Dietary Patterns. Retrieved February 4th, 2025, from https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-foods-support-healthy-dietary-patterns

5. Los Angeles Community Action Network (LA CAN). (2025). Food and Wellness: Food Justice. [Web log post]. Retrieved February 4th, 2025, from https://cangress.org/services/healthy-food-access/

6. Moore, L. V., Diez Roux, A. V., Nettleton, J. A., & Jacobs, D. R., Jr (2008). Associations of the local food environment with diet quality–a comparison of assessments based on surveys and geographic information systems: the multi-ethnic study of atherosclerosis. American journal of epidemiology, 167(8), 917–924. Retrieved February 4th, 2025, from https://doi.org/10.1093/aje/kwm394

7. Kern, D. M., Auchincloss, A. H., Stehr, M. F., Roux, A. V. D., Moore, L. V., Kanter, G. P., & Robinson, L. F. (2017). Neighborhood Prices of Healthier and Unhealthier Foods and Associations with Diet Quality: Evidence from the Multi-Ethnic Study of Atherosclerosis. International journal of environmental research and public health, 14(11), 1394. Retrieved February 4th, 2025, from https://doi.org/10.3390/ijerph14111394

8. American Psychological Association. (2010). The impact of food advertising on childhood obesity. Retrieved February 4th, 2025, from https://www.apa.org/topics/obesity/food-advertising-children

9. Powell, L. M., Leider, J., Schermbeck, R. M., Vandenbroeck, A., & Harris, J. L. (2024). Trends in Children’s Exposure to Food and Beverage Advertising on Television. JAMA network open, 7(8), e2429671. Retrieved February 4th, 2025, from https://doi.org/10.1001/jamanetworkopen.2024.29671

10. UCLA Center for Health Research and Policy. (2024). Food Insecurity. Retrieved February 4th, 2025, from https://healthpolicy.ucla.edu/our-work/food-insecurity 

11. California Department of Public Health in collaboration with Nutrition Policy Institute, UCANR. (2016). Obesity in California: The Weight of the State, 2000 – 2016. Retrieved February 4th, 2025, from https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/NEOPB/CDPH%20Document%20Library/RES_ObesityReport20002014.pdf 

12. UCLA Center for Health Policy Research. (2018.) California Health Interview Survey. Retrieved February 4th, 2025, from https://healthpolicy.ucla.edu/our-work/california-health-interview-survey-chis/access-chis-data

13. U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2030. (2024). Access to Foods That Support Healthy Dietary Patterns. Retrieved February 4th, 2025, from https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-foods-support-healthy-dietary-patterns

14. Gosliner, W., Brown, D. M., Sun, B. C., Woodward-Lopez, G., & Crawford, P. B. (2018). Availability, quality and price of produce in low-income neighbourhood food stores in California raise equity issues. Public health nutrition, 21(9), 1639–1648. Retrieved February 4th, 2025, from https://doi.org/10.1017/S1368980018000058

15. UCLA Center for Health Research and Policy. (2024). Press Release: California Health Interview Survey reveals alarming rates of food insecurity, hate incidents, mental health concerns, and challenges in accessing needed care. Retrieved February 4th, 2025, from https://healthpolicy.ucla.edu/newsroom/blog/california-health-interview-survey-reveals-alarming-rates-food-insecurity-hate-incidents-mental

16. Food Research and Action Center. (2024). Hunger and Poverty in America: Data and Statistics on Hunger. Hunger Quick Facts for 2022. Retrieved February 4th, 2025, from https://frac.org/hunger-poverty-america#:~:text=Race%20and%20ethnicity%3A%20Black%20(22.4,Latinx%20households%20(9.3%20percent

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