Food Desert in San Bernardino- A Barrier to Healthy Food Access

Food Desert in San Bernardino-A Barrier to Healthy Food Access

Policy Brief

Suborna Bhattacharjee & Farhan Danish

California State University, San Bernardino

Author Notes

Suborna Bhattacharjee and Farhan Danish, Department of Health Science and Human
Ecology, California State University, San Bernardino

This Policy Brief Paper was conducted as a requirement for course HSCI 660D. Special
thanks to Professor Nicole Henley for many helpful comments and support.

Correspondence concerning this article should be addressed to Suborna Bhattacharjee &

Farhan Danish. Department of Health Science and Human Ecology, California State University,
San Bernardino, 5500 University Parkway, San Bernardino CA 92407.
Food Desert in San Bernardino- A Barrier to Healthy Food Access

Executive Summary

Access to healthy and affordable food is an important determinant for a healthy diet and

feature of a healthy community. However, access to high-quality food is a challenge in many

parts of the U.S., particularly in low-income neighborhoods, and communities of color. San

Bernardino County has been identified as one of the worst in the U.S. in terms of access to

healthy food. United States Department of Agriculture (USDA) has identified more than half of

the census tracts in San Bernardino as food deserts. Moreover, San Bernardino County has the

worst ratio of the number of fast food restaurants in a region to the number of grocery stores

(RFEI) in California. As income is low and access to healthy food options are limited, a high

percentage of San Bernardino’s population fails to meet recommended dietary guidelines. This,

has contributed to high rates of obesity and chronic disease in the area. To improve food security

in San Bernardino, there are existing food programs in place, for e.g., CalFresh. Although these

programs offer food to the households in need, the struggle for nutritious foods remains. Food

insecurity and chronic diseases show an increasing trend in San Bernardino. We recommend

tailoring the existing food programs based on the underserved communities. It is important to

expand or incentivize healthy food retail development in target neighborhoods. Programs need to

be developed which help in aggregating and distributing fresh produce grown by local farmers to

reach low-income residents with great needs. Moreover, programs should be developed to

remove transportation barriers which create obstacles for farmers’ markets, mobile vendors,

community urban gardens, and grocery stores to locate in communities and areas with most food

insecure households. It is critical to engage community and stakeholders to ensure that healthy

food programs are aligned with the needs and context of targeted neighborhood.
Food Desert in San Bernardino- A Barrier to Healthy Food Access

Context and Importance of the Problem

Access to healthy and affordable food is an important determinant of a healthy diet and

feature of a healthy community. The areas where residents do not have access to an affordable and

healthy diet is termed as food desert (Cummins and Macintyre 2002). Food deserts may damage

public health by restricting the availability and affordability foods that may benefit health. Food

deserts exist in many parts of U.S., particularly in low-income neighborhoods, and communities of

color, tribal communities, and rural areas.

San Bernardino County can be identified as one of the worst in the U.S. in terms of access

to healthy food (Agboola et al., 2017, Raymundo et al., 2017). According to USDA, 32 out of 369

census tracts have been identified as high poverty/low access (HPLA) food deserts in San-

Bernardino. Food deserts are geographic areas that lack grocery stores within proximity to where

people live. HPLA are low-access census tracts where 50% or more of the population earns less

than 185% FPL(Federal Poverty Level). Moreover, San Bernardino County has the worst RFEI in

California. RFEI is a commonly used tool for evaluating food environment of a region, which is

based on the ratio of the total number of fast food restaurants in a region to the number of grocery

stores. It is alarming that the RFEI index in San Bernardino has increased from 5.72 in 2007 to

8.00 in 2010 (San Bernardino County: Our Community Vital Signs 2013 Data Report). The

combination of no nearby supermarkets and limited transportation leaves most low-income San

Bernardino residents with only small grocery and convenience stores near their homes. These

stores stock mainly processed foods, soft drinks, and alcoholic beverages, and also charge higher

prices for the same. Without affordable fresh food options, adults and children face fundamental

challenges to making the healthy food choices that are essential for nutritious, balanced diets.
Food Desert in San Bernardino- A Barrier to Healthy Food Access

Limited availability of healthy food has been associated with a less healthy diet, and living

in a neighborhood with a high density of fast-food restaurants increase the likelihood of becoming

obese, especially among people without cars. Based on Feeding America Food Insecurity

Mapping, we find that overall food insecurity rate in California is 11.7%, the average meal cost is

$3.14 and 77% people live below 200% poverty threshold. The meal cost in San-Bernardino is

$2.95 and less than 1% people live above 200% poverty threshold in San Bernardino (Gundersen

et al. 2018). These statistics also suggests that higher percentage of population in this area depend

on cheaper unhealthy food options.

As income is low and access to healthy food option is limited, very high percentage of San

Bernardino population depend on cheaper unhealthy food options. Hence, obesity and related

health problems such as type 2 diabetes and heart disease significantly affect San Bernardino area

residents. The rate of obesity among adults in the San Bernardino area is 72% (Abreu et al., 2018).

Among San Bernardino cities, the children obesity rate ranges from minimum of 27.4% in

Yucaipa to maximum of 46.1% in Colton in 2010 (Babey et al., 2012). Based on AskCHIS

queries, the county has a significantly higher rate of heart disease, diabetes and blood-pressure

compared to California (Figure 1). Moreover, the percentage of diabetes among San Bernardino

population is one of the highest in California. Based on CHIS data, the percentage of diabetes has

increased 71% since 2005 to 2013.

Food Desert in San Bernardino- A Barrier to Healthy Food Access

Figure 1: Percentage of San Bernardino and California Population Ever Diagnosed with Heart Diseases,
Diabetes and High Blood Pressure. Source: 2013 California Health Interview Surveys (UCLA Center of
Health Policy Research)

Poor health status of the San Bernardino population is associated with circumstances of

people and several environmental factors. It is alarming that, despite several state and federal food

programs in the area, the food insecurity in San Bernardino has shown an increasing trend over the

last 15 years (Figure 2). Access to healthy food is a major concern in this regard, which is mostly a

community-based factor, rather than an individual one, and state and federal policy

implementation is required for improving the condition. Once the stakeholders recognize food

deserts as a major factor behind food insecurity in the region, the leaders will be able to create state

and federal policies and tailor existing programs to best meet the needs of food insecure

households.
Food Desert in San Bernardino- A Barrier to Healthy Food Access

Figure 2: Prevalence of Food Insecurity among San Bernardino Households, 2001-2016.

Source: 2001-2016 California Health Interview Surveys (UCLA Center of Health Policy Research)

Critique of Policy Options

To improve food security in San Bernardino, there are several existing food programs and

resources for the public that may help support a nutritious diet, e.g., CalFresh, WIC program,

Elderly Nutrition program. CalFresh is a Supplemental Nutrition Assistance (SNAP) or food

stamp program which is the major assistance program focusing on helping low-income families

below a certain poverty line to supplement their food expense (Shimada, 2014; Leung et al.,

2015). To help the CalFresh members purchase healthy meals, a monthly monetary benefit is

provided on an electronic benefit transfer (EBT) card (Shimada 2014). Around 19% of people in

San Bernardino receive CalFresh benefits (Raymundo et al. 2017). WIC (women, infants, and

children) program is another major special supplemental nutrition program that supports

pregnant women and women with small children who are below 185% FPL with groceries

(Oliveira, 2009). WIC has 17 locations in San Bernardino to provide service to the participants.

In the San Bernardino WIC program, there are around 62K participants (Raymundo et al., 2017).

There are few food programs that exist for children at school in San Bernardino. One

major program is the national school lunch program that provides free and reduced- price
Food Desert in San Bernardino- A Barrier to Healthy Food Access

breakfast and lunch to children five days a week (Gunderson, 2017). Around 300K children

participated in the program in 2016 (Raymundo et al., 2017). There also exists a summer food

service program throughout San Bernardino at over 100 locations to provide free food to low-

income children and teenagers under 18 years old in the summer (Gordon et al. 2003).

San Bernardino County also has a nutrition program for older adults. The program

integrates with several provider organizations and has around 40 locations across San Bernardino

County. The nutrition program also delivers meals to homes if needed. More than 12k elderly

people participated in the program in 2016 (Raymundo et al., 2017).

Community action partnership (CAP) of San Bernardino is a part of national community

action network. CAP partners with many charitable and non-profit agencies to help low-income

families with food. CAP distributes food to several programs, e.g., food banks, soup kitchens,

and food basket programs (“Community Action Partnership of San Bernardino”, 2011). The

Mobile fresh bus is another significant resource for supporting nutritious diets for poor peoples.

It incorporates the concept of a grocery store in a bus which makes stops at several locations in

San Bernardino every month to provide healthy and fresh food to people (“Conquering Food

Deserts”, 2018). There also exists several food pantries throughout the county that collect and

distribute food to the population in need.

The main problem with the existing programs is that these programs are mostly designed

based on a broad picture of the food crisis across the county or state. However, significant

differences exist between neighborhoods and communities in terms of food access but these

programs fail to take this into account. Moreover, a significant gap exists in the target and

implementation. For example, Calfresh as a SNAP program provides monetary benefits to

participants for purchasing nutritious foods, but many participants may use it for buying
Food Desert in San Bernardino- A Barrier to Healthy Food Access

unhealthy products. Many low-income families also may not be eligible for the assistance

programs due to not meeting the federal eligible poverty level. More than 20% of eligible

families in San Bernardino for CalFresh are also not aware of it and end up not using the benefit

(Raymundo et al., 2017). Hence, it is essential to educate the families about the available

resources and possible chronic health issues. However, in most areas, limited number of

community health workers are associated with such food programs and the nutrition programs

fails to reach many eligible families. Transportation is another major issue contributing to the

failure of these food programs but has garnered very limited interest. Limited or no emphasis on

local community based programs is another probable factor behind the failure of many current

programs, which may be crucial in improving the condition in many communities.

Policy Recommendations

San Bernardino has been historically underserved and classified as a food desert. To

decrease food security and increase access to healthy food in food deserts like San Bernardino

requires creativity, resourcefulness and drive. Implementing a sustainable plan to bring fresh

food to the most underserved communities requires detail analysis, planning, and funding. In

addition to combating food access problems, programs should also focus on promoting and

increasing knowledge about healthy and fresh foods. It will be important to refine the programs

to improve efficiency and outreach.

Our first recommendation is to lay more emphasis on local community-based programs.

It is important to increase opportunities and support for urban agriculture. Vacant lands can be

transformed into urban farms and community gardens under such a program. In addition to

offering access to low cost and locally grown produce, the program can also provide community
Food Desert in San Bernardino- A Barrier to Healthy Food Access

members with classes on health education, and cooking classes to help transform farm-fresh

produce into a meal. The program could help sell produce subscriptions to community members

and residents at an affordable price. To sustain, the program can sell its products directly to local

businesses and corner stores. Community food grants can support the program as the focus is on

the needs of low-income residents. It is also crucial to stimulate community partners and

collaborations through outreach and visibility of the initiative.

The second recommendation will be to undertake a needs assessment every year across

communities to identify the barriers. The assessment information will be crucial to decrease the

gap in the knowledge about the need for a local community and will guide the new/existing food

policies to make desired impacts. Many zoning and planning regulations exist which make it

difficult for local vendors to locate in an underserved community. Based on the assessment, the

policy can be made to remove such barriers in food desert areas and expand food access. Tax

incentives may be offered to attract and retain supermarkets located in or nearby designated food

desert areas. Moreover, initiating programs to help corner stores, convenience stores, and liquor

stores to convert into healthy food retail outlets is also crucial. It is important to incentivize local

farmers by streamlining the permitting process of farmers markets. New permits can be given to

street vendors to sell healthy and fresh foods in low-income neighborhoods which will encourage

small entrepreneurs.

Transportation inequalities is another major factor which affects food inequality issues

significantly. Residents of many low-income communities may need to spend more than an hour

to reach supermarkets in San Bernardino due to significant urban sprawl and limited public

transportation in San Bernardino. We recommend to create some new bus routes that connect

neighborhoods in food-desert areas directly to nearby areas with many grocery stores. City
Food Desert in San Bernardino- A Barrier to Healthy Food Access

public transport can collaborate with participating grocery stores to offer customers free return

ride based on a minimum purchase.

The final recommendation is to increase outreach and visibility of existing programs.

Addition of more outreach staff in health programs can improve the effectiveness of a program

significantly. The outreach staff can focus on educating the underserved community of available

resources and the potential impacts of using such resources. The workers can also help increase

sign up for the available programs like Calfresh and participation in healthy community

programs.

References

Raymundo, T. et al. (2017). Food Security and Obesity in San Bernardino County 2017. San
Bernardino County Public Health Nutrition Program.
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Enhancing culture of health in food deserts: Reports of a community supported agriculture
study in San Bernardino, CA, International Journal of Food Research, 4, 1-11.
Gundersen, C., Dewey, A., Crumbaugh, A., Kato, M., & Engelhard, E. (2018). Map the Meal Gap
2018: A Report on County and Congressional District Food Insecurity and County Food
Cost in the United States in 2016 . Feeding America, 2018.
Abreu, C., Williams, E., Smith, A., Pak, E., Medina, E., Malika, N., & Baum, M. (2018). 7
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Food Desert in San Bernardino- A Barrier to Healthy Food Access

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Shimada, T. (2014). Lost Dollars, Empty Plates: The Impact of CalFresh Participation on State
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Gunderson, G. W. (2017). National School Lunch Program (NSLP). US Department of
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