Improving Unequal Food Access Requires Understanding and Addressing the Social Inequalities That Contribute to It

The food landscape in rural communities is shifting. Dollar stores have moved in as grocery stores have closed. However, we still know little about whether and how this has altered people’s food-shopping behaviors. In last month’s issue of AJPH, Feng et al.¹ used a national data set of food expenditures to chart changes in food spending at different types of retail outlets between 2008 and 2020. They found that, over this period, dollar stores grew faster than any other type of food retailer in terms of share of food spending and that rural households’ share outpaced that of other households.

The research by Feng et al. offers clear evidence of the need to consider dollar stores in conversations about improving food access, especially in rural areas. They also call for additional research on the implications for public health. We concur. Furthermore, we argue that improving unequal food access requires understanding and addressing the structural inequalities that contribute to it. We offer the following key considerations to ground this work.

First, it is important to recognize that rural areas are not a monolith. Rurality shapes food access in important ways, but food access also varies widely in rural areas. As Feng et al. show, rural Black households spend, by far, the largest share (11.6%) of their food budget at dollar stores, and the share of food spending at dollar stores is higher for rural households in the South. Similarly, many of the counties with the highest rates of food insecurity are rural Southern counties with large shares of people of color.² Structural racism, in the form of decades of disinvestment and discrimination, has shaped economic development and access to both social services and food in these communities.³

Second, to understand the implications of the increased reliance on dollar stores, we need to look more closely at how people are using them. As Feng et al. note, the stores themselves vary. Although many dollar stores carry only shelf-stable foods and beverages, others offer eggs, milk, and even fresh produce. We also know from previous research on food access that shopping patterns are complicated; people base their decisions on where to shop on a range of criteria, including proximity, price, and quality.^4,5 Understanding the particulars of food decisions requires paying attention to the stories and complexities of life for people in rural communities.

Between 2012 and 2020, we conducted four waves of semistructured interviews with 124 low-income female caregivers in North Carolina, including 85 rural households.⁶ In one set of interviews, we asked caregivers to describe their shopping habits in detail. Although most people shopped primarily at supermarkets,⁵ many—especially in the most rural county—also relied on dollar stores. Not surprisingly, proximity was important; people said that if they ran out of only one or two items, they would try to get it at the dollar store rather than going all the way to the supermarket (which was often much farther away). Many people also shopped at dollar stores purposefully as part of a strategy focused on feeding their families on very tight budgets. They discussed buying specific items at dollar stores—snacks, but also spices, canned goods, cereal, rice, bread, and even, participants told us, ground beef or frozen tilapia—because they were cheapest. Alyssa, a mother of three, said she went to the dollar store first to get sides and basics: “So I can see how much money I save before I go over [to the supermarket].” As Feng et al. point out, people make food decisions for complex reasons, and efforts to improve food access should start by recognizing this.

Third, it is important to consider how dollar stores affect communities. On one hand, dollar stores can serve as community assets as affordable and local options for buying food.⁷ On the other hand, they also can displace local businesses and often fail to offer healthy options such as fresh produce.^8,9 Improving dollar stores’ offerings requires understanding them as part of communities. Some of the caregivers in our study worked in dollar stores or had friends or relatives who worked in them. They talked about going to (or avoiding) specific stores because the employees were helpful or made them feel welcome (or, conversely, made them feel unwelcome). Dollar stores’ offerings also vary. Although previous research clearly shows that they offer fewer healthy items than supermarkets,⁸ some in our study were better than others (offering fresh meat or fish, for example, or frozen vegetables).

We also saw examples of how communities are partnering with dollar stores to improve food access. In one of the rural counties in our study, a family and consumer science agent connected local farmers who wished to sell their produce at dollar and corner stores in an effort to support local agriculture and make healthy, convenient snacks available to consumers. Anecdotes like these, although rare, demonstrate how community members need to be at the center of conversations about the impacts of dollar stores on the places where they live.¹⁰

Finally, we want to underscore what other researchers have also argued: food access is, most fundamentally, about money. It is important that people have access to stores offering the foods they need at prices they can afford. However, the most critical step for improving food access is addressing the systemic inequities that leave people without adequate economic resources. During the COVID-19 pandemic, various social support programs were created or expanded, providing a natural experiment on how increasing social support improves people’s access to food. Using repeated surveys of a nationally representative sample of US households, Shafer et al. showed how the introduction of advance payments for the Child Tax Credit was associated with a 26% reduction in household food insufficiency.¹¹ When the payments expired, food insufficiency increased.¹²

We conducted a qualitative study of experiences of food insecurity during the pandemic, interviewing families in rural and urban counties in five states (Michigan, Mississippi, North Carolina, South Carolina, and South Dakota).¹³ People told us that programs like the expansion of SNAP (the Supplemental Nutrition Assistance Program), stimulus checks, and the Child Tax Credit had allowed them to stock up on key freezer and nonperishable foods, sometimes for the first time in years, providing an important buffer against future food insecurity.

In closing, the analysis by Feng et al. offers an important glimpse into how food purchases are shifting in rural US communities. As public health researchers and practitioners seek to understand why these changes are happening and how they matter, it is critical to center the lives and histories of the people and communities who are most affected by these changes. We must use a food justice lens to improve food access, seeking to understand where inequities exist and who is affected, as well as how community members and leaders are responding.