What is… Biological Determinants of Health

What determines our health?

Dr. Bortz likes to explain it using the life of a car. “The life of a car depends on 4 elements: design, accidents, maintenance, and aging. If the car is a “lemon,” is involved in many accidents, or is poorly maintained, it will not have the chance to grow old. (1)” Our bodies work similarly. This is called the biological determinants of health.

What are biological determinants of health? For the purposes of simplification, biology is the study of the vital processes of life. For humans, that encompasses things we do that keep our body functioning correctly, or in contrast, what can deteriorate it faster. Internal factors such as how much or what we put in our body and how much exercise we do and don’t get, even factors outside our control like what genes we’ve inherited and external factors including bacteria and viruses, can significantly impact our health and quality of life. These are the biological factors that determine our health.

Some of these we can control. We can determine, to a certain point, our diet, whether we smoke or drink alcohol, and how much exercise we get. Other parts of our biology, paired with careful actions, can result in positive health outcomes. For example, someone with type 2 diabetes in their family history can reduce their risk of becoming diabetic through healthy regulation of their diet and exercise (2). There are biological determinants that are out of our control such as the deterioration of our body’s vital processes with age, but even as we age, how we treat our body can influence how fast our body ages and how resistant our body is to disease and harm.

This is where Well Fed is set up to make the most impact. We are focused on biology and behavior. We work in underserved communities where diet-related illness affects many people’s daily lives. The choices they make often determine their health outcomes. Some struggle to change bad habits and choose a healthy diet and as a result their diabetes or hypertension gets worse. Others will develop illnesses because they do not change their current lifestyle. However, we recognize the barriers they face which make choosing to cook and eat healthy difficult and sometimes out of reach.

Phinehas Adams / UNSPLASH

This brings us to the social determinants that drive health outcomes. These are the conditions in which a person is born, grows, lives, works, and ages that contribute to their health (3). The governmental policies, cultural values placed on health, your socioeconomic status— who you are in society as far as your income, occupation, education, ethnicity, and gender impact your health. Even psychological factors like if you have a healthy relational support network or have stressful living circumstances can all govern your ability to live and eat healthy.

There are organizations that hold an important role in working hard to influence policy and the conditions in which people live. Well Fed is in some of those conversations, but our expertise and where we can help the most is with the biological determinants that are causing poor health, hospitalizations, and death among under-represented communities in Arkansas.

We empower families to make healthy choices by providing them with consistent cooking and nutrition education. We’re giving them the tools so that they can construct a healthy lifestyle for themselves.

Each conversation about how to cook a particular vegetable and its related nutritional benefits is a step forward in real behavioral changes.

They see the importance and simplicity of cooking healthy. 1) We give them fresh fruits and vegetables so they can access it, because many of our participants have physical restrictions to healthy food access. They may live in a food desert (link), they could be disabled, or their transportation could be inconsistent. 2) Our participants can use the food we give to make the recipes they get from our education segment. 3) The healthy food we give them adds vital nutrients to what they already make!

The statistics in Arkansas are not good. In previous blogs we wrote about the devastating effects in the Natural State in regards to the obesity rates, rate of food insecurity among adults and children, and the risk of diabetes, hypertension, and heart disease. The social determinants need addressing, however, as Dr. Bortz explains (4),

it is evident that the biological factors are more proximate determinants than the socioeconomic contributors, which are upstream and ultimate in their role.

What goes into our bodies has the closest impact on our health outcomes! Although it may be a daunting task to impact behavior and biology in a way that heals people living in underserved communities in Arkansas, through the cooperation of our partners and our community, we can begin to change the future health of communities one person at a time.

Food Insecurity Won’t Be Fixed In Just a SNAP

SNAP (Supplemental Nutrition Assistance Program), formerly known as the Food Stamp Program, is a government program that provides food assistance to qualifying low-income individuals in order to mitigate food insecurity. In 1933, as a way to alleviate the struggle farmers were having selling excess crop supply, the Federal government purchased these commodities and distributed them among under-nourished communities.

The program today has certain requirements for those who can receive SNAP benefits and Arkansas’ are among the highest. These barriers prevent many eligible Arkansans from accessing the important nutrition they need. What these barriers are, how SNAP participants actually feel about the program, and how organizations like Well Fed that specialize in healthy food access are necessary while the system changes, will be answered in this blog.

Arkansas uses one of the strictest allowable asset limits for SNAP eligibility according to a report done by one of our local partners, the Arkansas Hunger Relief Alliance. They teamed up with local medical research organizations such as the Office of Community Health and Research at the University of Arkansas for Medical Sciences (UAMS) and the Center for Science in the Public Interest (CSPI) to interview SNAP participants and representatives from SNAP-focused organizations across Arkansas.

Their motive was to gather first-hand testimonies from actual SNAP stakeholders to learn the barriers to success in the program and come up with tangible strategies based on these stakeholders’ opinions and stories.

Mael BALLAND / Unsplash

Arkansas’ SNAP program provides assistance to over 330,000 individuals and has 2,808 authorized SNAP retailers. And although 330,000 is 11% of all Arkansans, only 66% of eligible residents accessed SNAP in 2018, compared to 82% nationally.

With 34% of eligible Arkansans living in need but not accessing government assistance and food insecurity levels in Arkansas climbing 5.2% since the pandemic started, the AHRA and UAMS set out to discover why.

For the 34% eligible, what are the barriers? As stated above, Arkansas has one of the strictest allowable asset limits for SNAP eligibility. That means they either can’t save in order to qualify for the program or they use their savings on food. Participants surveyed said this discourages saving among eligible participants.

Some other barriers mentioned by SNAP community stakeholders were the child support enforcement requirements (which research suggests only harms the children who wouldn’t receive the food), difficult application process, and negative stigma against SNAP users.

The amount of food and frequency of when participants receive it was a concern for participants, too. One SNAP stakeholder said:

When you got to stretch [your benefits] you will buy the cheapest thing. It’d be bologna, hot dogs, you know, a lot of processed foods […] because you’re trying to stretch your stamps out for the end of the month.

The current SNAP benefits could be indirectly encouraging unhealthy eating habits and, ultimately, the high percentage of diet-related illnesses in Arkansas. No one is causing it specifically, however, participants feel like the only reasonable method to make their government assistance last is to purchase unhealthy, cheap food.

Interviewees brainstormed ideas to solve it; increasing the amount of allocation and frequency was mentioned, however, passing such legislation would be difficult and without an accompanying education component, their diet is unlikely to change, they concluded.

There are parts of the program that encourage eating healthy. The Double Up Food Bucks program incentivizes participants by matching up to $20 for every dollar spent on FFV (Fresh fruits and vegetables) at participating locations. Participants did express opinions that the program needs to be more widely advertised because not everyone knows it exists.

Many FFV vendors are at farmers markets, which helps the local economic growth, but can be a barrier for participants who can’t go to these markets, feel embarrassed to use EBT (Electronic Benefits Transfer), or don’t feel like they fit in with the clientele of the market. There are thoughts on expanding eligible locations to supermarkets and even pick-up or delivery to eliminate this barrier.

SNAP is a very important program to help people in need and Well Fed was never meant to replace it, simply compliment it. The AHRA did this study intentionally to improve on a system that needs a refresh. Until legislation can improve SNAP benefit access, distribution, and improve incentives for eating healthy, Well Fed will be in communities in Arkansas where SNAP eligible participants live.

52% of our mobile market participants in low-income communities are not accessing SNAP benefits and 80% of our participants in a post survey said they needed continued assistance to access the healthy food they need.

Oh, snap! Clearly there is still a great need and we will be there for years to come to help supplement their diets with highly nutritious food and compliment the food assistance programs some currently use.

This blog is a synopsis of the whole article that you can find here.

If you or someone you know would like to apply for SNAP Benefits, please go to the Divisions & Shared Services website to learn more.

Cover photo by Pascal Bernardon

What is… Causing The Obesity Epidemic in Low-Income America

Fast, cheap, supersized food has been running through America’s veins since sliced bread was invented. Also driving the heartbeat of America is innovation and making everything bigger and cheaper. The popular Netflix series History 101 explains that culture shifted after World War II from mom cooking 1,095 meals a year to eating out due to higher disposable income, entertainment value, and convenience. Supply chains shifted and convenient food became cheaper with increased production. The US government began subsidizing farmers to grow high energy-dense commodities like corn, soybeans, and wheat to fuel rising demand (1).

One study discovered the American diet now derives close to 40% of daily energy (calories is the way we measure the energy in food) from added sugars and fats.

With such a high ratio it’s no wonder why the U.S has the lowest-cost food supply chain in the world (2). That begs the question, who is impacted by this low-cost, high-energy dense food system the most? Low-income households.

Refer back to the beginning of the first paragraph; it was higher disposable income that allowed for convenient consumption of fast food. Fast-forward to today. Processed, high energy-dense foods are still convenient, but add to convenience, affordability and accessibility. And it’s not just fast food, but grocery store shelves are loaded with calorie heavy products.

Photo by Nathalia Rosa/Unsplash

Now the tables have turned. People with lower disposable income are consuming this low-nutrient food. But do they have a choice or has the low-cost U.S. food supply chain inevitably determined what the low-income households can purchase?

Harvard researchers discovered that the healthiest diets were $1.50 more expensive than the least healthiest diets (3), so the actual cost of a healthy diet, independent of location, is higher. However, there is a general food price gap by location, too. We see that inner-city grocery stores, where many low-income communities are, have 4% higher prices overall than suburban areas due to less competition, less mobility for clients to respond to higher prices, and smaller stores with higher margins and therefore higher costs (4).

Another factor to consider is the role government-subsidized farming plays on the price of food. A subsidy is money that the US government gives to farmers in order that they are protected against changing prices of what their crops sell for and the amount of crops they are able to grow in a season. There are a few crops that are highly subsidized because US farmers are very efficient at producing them: wheat, soybeans, and corn (5).

Photo by Scott Goodwill/Unsplash

Large farms will grow these highly subsidized crops and grow less crops like fruit, vegetables, and other grains. This drives the cost of processed, pre-packaged foods down while increasing the cost of much-needed nutrient rich produce.

So, families with low-incomes, attempting to keep a food budget with a low salary or government assistance, will be primed to purchase energy-dense foods, at higher proportions, containing grains, added sugars, and added fats (6). And when they live in a food desert, the chances that they will find healthy fruits and vegetables decreases substantially because typically only convenience stores occupy retail space in food deserts. Furthermore, price is not the only point to consider; taste, nutritional knowledge, and confidence in cooking healthy meals are motivating when choosing food, too.

Changes in the food system from the top down through Government policy is a complex and arduous process. In the meantime grass-roots and state level action is vital for impacting the statistics now.

Well Fed is strategically set up as a mobile healthy food and nutrition education non-profit for this exact reason. We work with local and state partners to bring fruits, vegetables, grains, dairy, and meat, all products that tend to be expensive or inaccessible, directly to low-income communities. We partner with nutritionists to educate them about how to shop smart, cook healthy, and know the nutritional value of their food. Whether or not healthy food prices decrease, the US government starts to subsidize

healthy food, or more inner-city grocery stores open up and the general price of food decreases, Well Fed will be innovating programs and serving underserved, low-income communities in Arkansas.