food equity in knox county

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Food Equity in Knox

CountyCommunity Assessment

Fall 2008

University of Tennessee Knoxville

Public Health Nutrition

Graduate Students

2

Background

Household Food Security

National Nutrition & Related Research Act of 1990

Ten Year Comprehensive Plan for NNMR

↓

1. Instrument

Federal Food Security Measurement Program

2. Definitions:

food security

food insecurity

hunger

Source: Cohen

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CategoryClassification

DefinitionOld Term New Terms

Food Security Food Security

High Food SecurityNo reported indications of food-

access problems or limitations

Marginal Food

Security

One or two reported

indications—typically of anxiety

over food sufficiency or shortage

of food in the house. Little or no

indication of changes in diets or

food intake

Food Insecurity

Food Insecurity

Without Hunger Low Food Security

Reports of reduced quality,

variety, or desirability of diet.

Little or no indication of reduced

food intake

Food Insecurity With

Hunger

Very Low Food

Security

Reports of multiple indications of

disrupted eating patterns and

reduced food intake

USDA Food Security Labels and

Definitions (Nord)

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Community Food Security

Environments vs. People

Challenges/Conditions:

Social

Geographical

Institutional

Economic

Source: Cohen

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USDA’s Community Food Security

Assessment Toolkit: There are inadequate resources from which people can purchase

foods.

The available food purchasing resources are not accessible to all community members.

The food available through the resources is not sufficient in quantity or variety.

The food available is not competitively priced and thus is not affordable to all households.

There are inadequate food assistance resources to help low-income people purchase foods at retail markets.

There are no local food production resources.

Locally produced food is not available to community members.

There is no support for local food production resources.

There is any significant household food insecurity within the community.

Source: Cohen6

Post WWII

Suburban migration of middle

class

Pursuit of food retailers

Present

Few small and scattered

independently-owned grocery

stores

More large suburban chain

supermarkets

“Food Desert”

-insufficient food resources to maintain a healthy diet

-supermarkets

ImpactRural and urban food deserts emerged.

Low-income neighborhoods disadvantaged.

Short, Smoyer-Tomic et al

Donkin, Larsen, Moreland, Powell

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↓ affordability

↓ variety

↑low-income

↑minorities

Summary of Research Findings &

Implications for Public Health

Health Disparities?Donkin, Moreland, Powell, Wang et al

8

Foundation of health disparities complex

Important to investigate many possibilities and angles

individual to system

Macro-Level Environment

Physical Environment Social Environment

Individual Factors

Health

Story

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Goals and Objectives

A. Describe the people and geography of Knox County

Gather and analyze secondary demographic data by sector on total population, gender, age, race, education, income, and employment

Compare Knox County demographics to countywide and statewide figures

Assess health status of Knox County residents using secondary morbidity and mortality data

Identify pertinent trends using available Sector Plans of the Knox Metropolitan Planning Commission

B. Identify possible food inequities in Knox County.

Assess food resource availability by evaluating quantitative data on the total numbers and types of food resources in relation to demographic features of each of the twelve sectors of Knox County

Assess food resource availability and affordability by conducting market basket surveys on three food resources in each of the twelve sectors of Knox County

Compare food resource data with health status indicators10

Goals and Objectives

C. Establish priorities to improve the food environment of Knox County.

Assess availability of and participation in food assistance and distribution programs.

Evaluate results in relation to morbidity and mortality data

D. Provide recommendations for policy and program initiatives, if applicable, and for further research

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Methods

Research Design

Each of Knox County’s 12 planning sectors were

independently researched by sub-committees and

compared to the county as a whole looking at:

1. Demographics

2. Food availability

3. Food affordability

4. Food accessibility

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Data Sources: Demographics

Moving to the Future (http://www.movingtothefuture.org/)

Figures related to total population, gender, age, income,

poverty, employment, race/ethnicity, education, and language

spoken, and additional household factors

Information gathered from: Metropolitan Planning

Commission (MPC) website, (http://www.knoxmpc.org)

Data Sources: Food Availability

Food Resources as Plotted by MPC

Grocery/Supermarkets

Secondary Food Retailers

Convenience Stores

Data Sources: Food Availability

Beer/Wine/ Liquor StoresRestaurants

• Limited service

• Full service

• Snack & Non alcoholic

• Cafeterias

Markets

• Fish and Seafood Markets

• Fruit and Vegetable Markets

• Baked Good Stores

• Meat Markets

Emergency Food Service

Additional Food Resource Considerations

Data Sources: Food Affordability

Market Basket Survey

United States Department of Agriculture’s Thrifty

Food Plan

1. Feeds a family of four for a week

2. Meets nutrient needs

3. Determines average grocery bill

Data provided by United States Department of Agriculture

TFP Weekly Food UsageFruits Fresh

Apples (5 small) 1 lb 4 oz

Bananas (11 medium) 2 lb 12 oz

Grapes 1 lb 8 oz

Melon 1 lb

Oranges (22 small) 4 lb 12 oz

Vegetables

Carrots 1 lb

Celery 5 oz

Green pepper 4 oz

Lettuce, leaf 9 oz

Onions 1 lb 4 oz

Potatoes 10 lb 8 oz

Tomatoes 6 oz

Canned Fruits

Oranges, mandarin 13 oz

Peaches, light syrup 1 lb 10 oz

Canned Vegetable

Mushrooms 4 oz

Spaghetti sauce 26 oz

Tomato sauce 8 oz

Frozen

Orange juice concentrate (7) 12-oz cans

Broccoli 6 oz

French fries 11 oz

Green beans 1 lb 7 oz

Green peas 15 oz

Breads, Cereals, and Other Grain Products

Bagels, plain, enriched (4) 8 oz

Bread crumbs 3 oz

Bread, French 4 oz

Bread, white, enriched 2 lb

Bread, whole wheat 1 lb

Hamburger buns 8

Dinner rolls 4

Corn flakes 1 oz

Toasted oats 10 oz

Flour, white 1 lb 7 oz

Macaroni 1 lb 5 oz

Noodles, yolk-free 1 lb 2 oz

Popcorn, microwave 3 oz

Rice, white 3 lb 2 oz

Spaghetti 11 oz

Milk and cheese

Evaporated milk 4 oz

Milk, 1% 9 qt

Milk, whole 4 qt

Cheese, cheddar 2 oz

Cheese, cottage 7 oz

Cheese, mozzarella 1 ozData provided by United States Department of Agriculture

TFP Weekly Food UsageMeat and Meat Alternates

Beef, ground, lean 3 lb 15 oz

Chicken, fryer 1 lb 13 oz

Chicken thighs 2 lb 12 oz

Fish, frozen 2 lb

Tuna fish, canned 12 oz

Pork, ground 1 lb 7 oz

Turkey, ground 1 lb

Turkey ham 11 oz

Beans, kidney 15 oz

Beans, vegetarian, baked 1lb 9 oz

Eggs, large 17

Fats and Oils

Margarine, stick 15 oz

Shortening 4 oz

Salad dressing, mayo 6 fl oz

Vegetable oil 9 fl oz

Sugars and Sweets

Sugar, brown 1 oz

Sugar, powdered 3 oz

Sugar, granulated 9 oz

Jelly 8 oz

Molasses 1 fl oz

Pancake syrup oz

Chocolate chips 2 oz

Fruit drink 1 gal

Fudgesicles 4

Condiments and Spices

Baking powder .02 oz

Baking soda .18 oz

Black pepper .16 oz

Catsup 1.06 oz

Chicken bouillon .71 oz

Chili powder .79 oz

Cinnamon .08 oz

Chocolate drink powder 1.52 oz

Cumin .05 oz

Onion powder .22 oz

Garlic powder .40 oz

Gelatin, unflavored 2.25 oz

Italian herb seasoning .03 oz

Lemon juice, bottled .54 oz

Oregano .18 oz

Paprika .11 oz

Salt .13 oz

Soy sauce 2.26 oz

Vanilla .52 oz

http://www.movingtothefuture.org/

http://www.knoxmpc.org

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Data Sources: Food Affordability

Market Basket Food Survey Instrument Sample

Food Item

Item

Weight/ Unit

(Desired)

Item

Weight/Unit

(Actual)

Price

(Lowest

Cost)

Fruit—fresh

Apples, any variety

(bagged or loose) Per lb

Bananas Per lb

Grapes (green or red) Per lb

Melon (cantaloupe,

honeydew, or watermelon) Per lb

Oranges, any variety

(bagged or loose) Per lb

Data provided by United States Department of Agriculture

Data Sources: Food Accessibility

Knoxville Area Transit (KAT)

Photos

Data Analysis: Food Affordability

Average Sector Market Basket Price (ASMBP)

Average price of individual food items

Average price per food category

Demographics against Market Basket Research

Food Resource evaluation and comparison

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Community Characteristics

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Knox County Summary

Knoxville:

103.7 sq. mi.

46% of the total county population

2000 Census data: Total Population 382,000 individuals

14% increase from 1990 Census data

Traffic flow is a major concern

Existing roadways are inadequate for needs of increasing population and development

Currently seeking to meet needs by:

Expanding sidewalk networks

Increase bicycle paths

Knoxville Area Transit (KAT)

Data provided by Knoxville Metropolitan Planning Commission

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Knox County Summary

Per Capita Income in 2006: $33,963

Unemployment rate 2006: 3.9%

Employed labor force:

Education, health, and social services occupations

Majority Knox County residents:

White (88%), Black (8.6%)

13 % of population were at or below the poverty

level

2000 Census data provided by Knoxville Metropolitan Planning Commission

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Source: Knoxville Metropolitan Planning Commission

Total Population of Knox County

East County, South City, and South

County: fewest number of individuals

Northwest, North, and Southwest Counties:

largest number of people


Population Distribution & Gender


Race & Ethnicity by Sector


Income by SectorFamilies and Individuals in Poverty


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Unemployment Rates of Knox County

Sectors

Sectors Rate (%) Tennessee

(%)

United

States (%)

Central City 11.6

7.2 6.5South City 7.1

West City 3.1

Southwest

County

2.8



Unemployment by Sector

Education Level & Income

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Southwest County & West City

↑ % bachelor’s & professional

degrees

↑ mean family income

Central City

↑ % education < 9th grade

↓ mean family income

VS.

Data provided by Knoxville Metropolitan Planning Commission

Household Characteristics

Mean House

Value

Southwest County &

West City

Central City

>$200,000 $58,000

Vehicles per household

Southwest & Northeast

County

2.0

Central City 1.2

Average of Knox

County

1.78


352000 Census data provided by Knoxville Metropolitan Planning Commission 41

Market Baskets

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Retail Food ResourcesSector Name Grocery/

Supermarket

(8%)

Convenience

Stores

(18%)

Beer/Wine/

Liquor

Stores

(4%)

Restaurants

(61%)

Secondary

Food Retailers

(7%)

Markets (Meat/

Seafood/Fruit/

Vegetable/Bakeries)

(3%)

Total

Central City 19 30 7 136 9 10 211

East City 10 16 4 49 8 1 88

North City 5 18 5 63 6 2 99

Northwest City 6 18 4 67 10 1 106

South City 6 12 2 33 5 3 61

West City 11 20 6 140 12 10 199

East County 6 15 1 21 2 1 46

North County 4 22 3 49 8 2 88

Northeast

County

6 12 0 8 2 0 28

Northwest

County

10 30 4 56 10 2 112

South County 3 10 3 21 3 1 41

Southwest

County

11 32 9 139 15 5 211

Total 97 235 48 782 90 38 1,290


People Served by Grocery/Supermarkets and

Total Retail Food ResourcesSector People per

Grocery/Supermarket

People per Retail Food

Resource

Central City 2,534 228

East City 2,547 289

North City 5,068 255

Northwest City 4,662 263

South City 3,086 303

West City 1,815 102

East County 2,218 289

North County 10,639 483

Northeast County 3,636 779

Northwest County 6,286 561

South County 6,412 469

Southwest County 5,129 267

Knox County Average 3,713 279


Average Sector Market Basket Price

2000 Census data provided by Knoxville Metropolitan Planning Commission 2000 Census data provided by Knoxville Metropolitan Planning Commission

Fresh Fruits and Vegetables

As a Percent of Average Sector Market Basket

Price

Meat & Dairy Cost as a Percentage of Average Sector

Market Basket Price

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Average Food Basket Price as a Percentage of

Mean Income by Area Photographs: Retail Food Resources

Highest income sector:

Southwest County

Walgreens

Lowest income sector:

Central City

Walgreens

Photographs: Retail Food Resources

Second highest income

sector: West City

Kroger

Second lowest income

sector: South City

Kroger

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Community Resources

Food Pantries

80 food pantries

Range of operation from once a month

to five days per week

Some offer free clothing and furniture

Information from Knoxville Community Action Committee

Food Pantries County Wide

Food Pantry List provided by the Knoxville Community Action Committee. Pantries plotted on Google Map.

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Food Pantries Downtown

Food Pantry List provided by the Knoxville Community Action Committee. Pantries plotted on Google Map.

Community Resources Community Action Committee (CAC)

Homeward Bound Program

Head Start

Office on Aging

Beardsley Farm

Emergency Food Helpers

National School Lunch Program

National School Breakfast Program

Second Harvest Food Bank

Supplemental Nutrition Assistance Program (SNAP)

Tennessee Nutrition and Consumer Education Program (TNCEP)

Supplemental Nutrition Program for Women, Infants, and Children (WIC)

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Transportation

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Transportation

Central City has 1.2 vehicles per household

Increase reliance on restaurants and

convenience stores

Vehicles per household

Southwest & Northeast

County

2.1

Central City 1.2

Average of Knox

County

1.78


Map of Knoxville Area Transit (KAT) System

Map provided by Knoxville Area Transit website (http://www.ci.knoxville.tn.us/kat/)

Retail Food Resources

Allows access to retail food resources

Kroger- 9 routes

Food City- 5 routes

Wal-Mart- 4 routes

Information provided by Knoxville Area Transit website (http://www.ci.knoxville.tn.us/kat/)

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Discussion

61

Community NeedsThere is a paradox of high availability and

low affordability of food in low income and minority sectors

Market Basket survey showed food prices are higher in low income and minority sectors compared to more affluent and primarily Caucasian sectors

Restaurants and convenience stores represent the majority of food resources in every sector

Moreland et al. (2002)

Neighborhood characteristics associated with the

location of food stores and food services places

Findings:

1. Supermarkets were less prevalent in low-

income minority populations

2. Restaurants were most prevalent in low-

income minority populations

3. Fewer households in poor neighborhoods had

access to private transportation62 63

Minority Sectors


64

Central and East City

High amount of Grocery stores

- Central and East City have 19 and 10

grocery stores respectively

Lowest mean incomes

Sector Mean Family Income

East City $36,486

Central City $32,961

Mean County Income $53,978


65

Northeast County and South County Low amount of Food stores

- Northeast County and South County have 6 and

3 grocery stores respectively

Average mean incomes

65

Sectors Mean Family Income

South County $59,193

Northeast County $49,608

Mean County Income $53,978


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66

Market Basket Disparities

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Restaurants and Convenience Stores

Restaurants outnumbered grocery and

supermarkets in every sector

Restaurants were 61% of retail food source

and grocery supermarkets were 8%

Local Food Environment

Prevalence of overweight and obesity

Environmental influences on diet an partly

considered to involve two pathways:

1. Access to foods for home consumption from

supermarkets and grocery stores

2. Access to ready made food for home and

out-of-home consumption

Source: Moreland et al. (2006); Cummins et al. (2005)

68 69

Household Characteristics

673 homes in Central City without

kitchen facilities

- Food storage and preparation

- Other food alternatives


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In Conclusion

Campbell C. Food Insecurity: A Nutritional Outcome or a Predictor Variable? Journal of Nutrition. 1991; 121: 408-415.71

Future Considerations Distinguish various restaurants available within

communities

Assess affordability and accessibility of public transit

services

Involving Key Stakeholders

Obtaining community’s perception

Photovoice

Source: Goodhart FE et al

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References

Campbell C. Food Insecurity: A Nutritional Outcome or a Predictor Variable? Journal of Nutrition. 1991; 121: 408-415 Cohen B. United State Department of Agriculture Economic Research Service. Community Food Security Assessment Toolkit. http://www.ers.usda.gov/Publications/EFAN02013/. Updated July 2002. Accessed November 21, 2008.

City of Knoxville. Fares and Passes. http://www.cityofknoxville.org/kat/web%20pages/general%20info/Fares.asp. Updated December 1, 2008. Accessed December 2, 2008.

City of Knoxville. Bus Route Destinations. http://www.cityofknoxville.org/kat/web%20pages/Schedules/Destinations.asp. Updated April 6, 2008. Accessed December 2, 2008.

Goodhart FE, Hsu J, Baek JH, Coleman AL, Maresca FM, Miller MB. A view through a different lens: photovoice as a tool for student advocacy. Journal of American College Health. 2006; 55:53-56.

Larsen K, Gilliland J. Mapping the evolution of 'food deserts' in a Canadian city: Supermarket accessibility in London, Ontario, 1961-2005. International Journal of Health Geographics. 2008; 7 (Art. No. 16).

Metropolitan Planning Commission (MPC) Planning Sectors. Knoxville/Knox County MPC. PDF File of Each Sector, Source US Census Bureau. http://www.knoxmpc.org/locldata/census00/sectmap.htm Updated September 2002. Accessed October 2008.

References

Metropolitan Planning Commission (MPC) Sector Plans Online. Knoxville/Knox County. http://archive.knoxmpc.org/plans/sectorpl.htm Updated February 2002. Accessed October 2008.

Morland K, Wing S, Roux AVD, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J of Prev Med. 2002; 22(1):23-29.

Morland K, Roux AVD, Wing S. Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study. Am J of Prev Med. 2006; 30(4):333-339.

Morland K, Diez Roux AV, Wing S. Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study. J of Prev Med. 2006; 30:333-339.

Nord M. United State Department of Agriculture Economic Research Service. Food Security in the United States: Definitions of Hunger and Food Security. http://www.ers.usda.gov/Briefing/FoodSecurity/labels.htm. Updated November 17, 2008. Accessed November 21, 2008.

Powell L, Slater S, Mirtcheva D, Bao Y, Chaloupka F. Food store availability and neighborhood characteristics in the United States. Preventive Medicine [serial online]. March 2007; 44(3):189-195. Available from: Academic Search Premier, Ipswich, MA. Accessed November 20, 2008.

References

Probert K. Moving to the Future. Population Profile Worksheets. http://www.movingtothefuture.org/story_files/226/226_ss_file3.pdf. Updated 2006. Accessed October 2008.

Short A, Guthman J, Raskin S. Food deserts, oases, or mirages? Small markets and community food security in the San Francisco bay area. Journal of Planning Education and Research. 2007; 26 (3): 352-364.

Smoyer-Tomic KE, Spence JC, Raine KD, Amrhei C, Cameron N, Yasenovskiy V, Cutumisu N, Hemphill E, Healy J. The association between neighborhood socioeconomic status and exposure to supermarkets and fast food outlets. Health Place. 2007; 14:740-754.

Timperio A, Ball K, Roberts R, Campbell K, Andrianopoulos N, Crawford D. Children's fruit and vegetable intake: associations with the neighbourhood food environment. Prev Med. 2008; 46: 331-335.

United States Department of Agriculture. Community Food Security Assessment Toolkit.http://www.ers.usda.gov/publications/efan02013/efan02013.pdf. Updated July, 2002. Accessed November 21, 2008

Wang MC, Kim S, Gonzalez AA, MacLeod KE, Winkleby MA. Socioeconomic and food-related physical characteristics of the neighbourhood environment are associated with body mass index. J Epidemiol Community Health. 2007; 61:491-498.

Questions???

http://www.ers.usda.gov/Publications/EFAN02013/

http://www.cityofknoxville.org/kat/web pages/general info/Fares.asp

http://www.cityofknoxville.org/kat/web pages/Schedules/Destinations.asp

http://www.knoxmpc.org/locldata/census00/sectmap.htm Updated September 2002

http://archive.knoxmpc.org/plans/sectorpl.htm

http://www.ers.usda.gov/Briefing/FoodSecurity/labels.htm

http://www.movingtothefuture.org/story_files/226/226_ss_file3.pdf

http://www.ers.usda.gov/publications/efan02013/efan02013.pdf