Patricia Canning feels the burden of America’s obesity epidemic every day. As an emergency medical technician, the 24-year-old Hyde Park resident carries patients on a stretcher to an ambulance, then transports them to a hospital. The more Americans pack on the pounds, the more difficult her job becomes.
“When I’m working, if I take ten patients a day, at least seven of them are overweight,” she said. “It could be all ten.” To accommodate bigger bodies, ambulances frequently double the truck’s manpower and use extra-wide bariatric stretchers, which can carry up to 700 pounds and feature adjustable handlebars.
“With me being athletic in high school and still now — I go to the gym — I’m able to carry a lot of weight, but it’s difficult,” said Canning, who is also studying to become a nurse.
Canning tells the story of a co-worker who fell trying to carry a patient up a flight of stairs. “He hit his face on the concrete,” Canning recalls. “He has scratches on his ear, and he [now] has a huge line of scar tissue from the outside of his eye to his hairline. That was crazy.”
In Boston, 23 percent of all adults are obese. Low-income communities of color are disproportionately affected — 32 percent of blacks, 30 percent of Latinos, and 33 percent of those with an income less than $25,000 are obese, according to the Boston Public Health Commission.
These numbers are rising dramatically — the obesity rate in Massachusetts has nearly doubled since 1995 — and with them, rates of chronic diseases like diabetes, high blood pressure, heart disease and cancer have also risen.
Although the link between diet and overall health is well-documented, maintaining a nutritious diet is not always easy, especially for low-income communities of color. Like many other social justice issues, disparities in food access and health frequently fall along racial and economic lines. While Boston is among the healthiest cities in the nation, disparities in food access persist, and for many people, have become a serious roadblock to health.
Affordability is the most basic obstacle to healthy eating, especially in the economic recession. The cost of food is steadily increasing, leaving many families unable to afford even the basics.
At the Stop & Shop in Roxbury’s Grove Hall for instance, a gallon of generic milk jumped 20 cents between January 2010 and August 2011, from $3.79 to $3.99, and a gallon of Hood brand milk increased 40 cents, from $4.59 to $4.99. Other staples like eggs and bread have also gone up. In January 2010, a dozen of large, brown Stop & Shop brand eggs were $1.99. In August of this year, the same carton was $2.29.
Bostonians are taking notice. “Healthy food, you’re gonna have to spend, you’re gonna have to dig deep,” said Dorchester resident Percy Bobbitt. “The economy’s messed up right now, sometimes the money’s just not there.”
The Boston landscape reflects national trends. According to the Consumer Price Index, the cost of milk, bread, eggs, fresh chicken, apples and ground beef have all been going up. In July 2001, the national average for a gallon of milk was $2.93. Today, it has jumped to $3.65.
These growing food prices have a clear effect on many families’ ability to afford healthy food and have become an “underlying systematic issue” in public health, according to Anne McHugh, division director of chronic disease at the Boston Public Health Commission. “Rates of food insecurity have gone up significantly since 2008,” she continued. Food insecurity, or difficulty putting food on the table, affects 38.8 million people nationwide, including 16.2 million children, the U.S. Department of Agriculture estimates. “The utilization of food pantries has just skyrocketed. So, unquestionably, people’s ability to eat healthy — and to eat enough — is directly correlated with income,” McHugh said.
In a 2008 report, the Boston Medical Center found that Supplemental Nutrition Assistance Program (SNAP) benefits were insufficient to cover the cost of a healthy diet. The report compared the local cost of the Thrifty Food Plan, the federal government’s standard for a “nutritious diet at a minimal cost,” and the maximum local SNAP benefit and concluded, “In Boston, the average monthly cost of the Thrifty Food Plan (TFP) was $752, 39 percent higher than the maximum monthly food stamp benefit for a family of four. A family receiving the maximum benefit would need an additional $210 per month to purchase a healthy diet.”
The Greater Boston Food Bank reached a similar finding — on average, SNAP benefits only last 2.6 weeks, leaving recipients vulnerable the remainder of the month.
This gap in coverage affects an increasing number of Bostonians. Between 2005 and 2010, the number of Boston SNAP participants grew an astounding 91.1 percent, from 57,052 to 109,049 people, a hike that represents both increasing economic need and greater government outreach. Nearly a quarter of black households in Boston receive SNAP benefits, according to the State of Black Boston 2010 report. The numbers are even higher for youth — 45.2 percent of all black youth, and 51 percent of Latino kindergarteners live with families that receive SNAP.
Although monthly SNAP benefits in Massachusetts have also increased in an attempt to keep pace with growing need — the maximum benefit for a family of four increased $80 between 2008 and 2011 — it is far from enough.
In the face of rising food prices and declining wages and employment, many are turning to emergency food assistance agencies. The Greater Boston Food Bank has witnessed a 23 percent increase in the number of people it has served since 2005 — in 2010, the GBFB served nearly 400,000 distinct individuals.
“We are a key part of the food chain in the city right now,” said Paul Colligan, director of programs at the GBFB.
Many of these food pantry clients report facing the dilemma Anne McHugh called “eat, heat, or treat.”
Forty-four percent of GBFB clients choose between food and utilities or heat, 37 percent between food and medical care, and 34 percent between food and rent or a mortgage payment.
Brad Gregory witnesses the problem of affordability everyday in his work as a nutritionist at the Uphams Corner health clinic in Dorchester. “People do talk about the cost of it, the cost of food,” he said. “It is a constant worry for our clientele. It’s a constant problem.”
Molly Shaw, another nutritionist at the same health clinic, finds the price of food to be a barrier in her own work. “I sit here and tell people to fill up their plates with fruits and vegetables, but that’s expensive,” she said. “For the people who aren’t really motivated, that cost barrier ... it makes it that much more challenging to get to the healthy diet.”
A study conducted by the Boston Collaborative for Food and Fitness found that in the six Boston neighborhoods with the highest rates of chronic disease and obesity — Jamaica Plain, East Boston, Roxbury, North Dorchester, South Dorchester, and Mattapan — 60 percent of survey respondents do not eat vegetables on a daily basis, and 14 percent do not eat any vegetables at home. Fifty-nine percent of these people report that their grocery store is affected by rising food prices, and as a result, 17 percent skip meals and 13 percent serve fewer vegetables.
Healthy food is clearly unaffordable for many Bostonians. But opting for junk food as a way to save money, which many families resort to, is no solution. A price survey in Roxbury and Dorchester proves that processed foods are far more expensive than healthy alternatives.
For instance, raw boneless chicken breast at America’s Food Basket on Geneva Avenue in Dorchester costs $2.99 per pound. Frozen fried ranges from $3.92 per pound to $6.72 per pound — considerably more expensive and less nutritious than its raw counterpart. At McDonald’s, the chicken served in its sandwiches comes to $13.49 per pound. While the pre-cooked and restaurant chicken may save on time and convenience, in terms of price, the healthy option is by far the cheapest.
Black beans from the same grocery store cost $1.10 per pound, and pinto beans cost under $1 per pound. Compared to other forms of protein, frozen beef patties at $3.99 per pound and a McDonald’s hamburger at $16.36 per pound, beans are the healthiest and most cost efficient protein.
A pound of raw potatoes at Tropical Foods grocery store in Dudley Square is 89 cents per pound. Ruffles potato chips, however, cost $7.23 per pound, and McDonald’s french fries come to $5.89 per pound.
Even green vegetables win the price comparison. Collard greens and bell peppers are 99 cents per pound, cabbage is 79 cents per pound, and broccoli is $1.59 per pound. Again, healthy options are the cheapest.
Among breakfast cereals, the same pattern emerges. Quaker oats cost $1.90 per pound at Tropical Foods, while Froot Loops are $6.15 per pound, Honey Nut Cheerios $5.60 per pound, and Frosted Flakes $4.41 per pound.
For residents on a tight budget, unhealthy processed foods are not the answer.
But the cost of junk food is even higher than its store price. Tax dollars go to federal subsidies for corn and soy, main ingredients in the production of beef, soda and other processed foods, to bring down the price of junk food. Adjusted for inflation, in recent decades the price of fresh produce has increased by 40 percent, while the price of soda and other processed foods have decreased 30 percent, according to New York Times food writer Mark Bittman. But even with government support, junk food is still costly.
“In general, despite extensive government subsidies, hyper-processed food remains more expensive than food cooked at home,” Bittman writes.
Perception of affordability also has an effect on weight, a finding in the Boston Public Health Commission’s Health of Boston 2010 report suggests.
“A lower percentage of adults who were obese agreed that the price of fruits and vegetables at the shop where they buy most of their food was affordable compared to adults who were overweight and adults who were underweight/normal weight,” the report stated.
While income disparity may play a role in this finding, the statistic also suggests that perception of the cost of nutritious food is related to one’s health. Those who think fruits and vegetables are affordable will buy them and are more likely to be healthy, while those who think fruits and vegetables are unaffordable will not buy them, and are less likely to be healthy. Moreover, those who are healthy and buy produce are also more likely to know its true cost — relatively affordable.
Next week’s installment will address the challenge of food access in Boston. This series was funded by the University of Southern California National Health Journalism Fellowship.