In South Carolina, Access to Food and Access to Healthy Food Aren't the Same Thing

Feb 16, 2021

South Carolina grows and sells plenty of healthy food. The problem is, not everyone can get to it easily. In a pandemic that preys on poor health, that can be trouble.
Credit Scott Morgan / South Carolina Public Radio

For ways you can help, scroll down to the bottom of this story.

On the upside, South Carolina is a bounteous food state. We grow almost 5 million acres worth of food on 25,000 farms and have excellent trade partnerships with food growers in other states. There is no shortage of fresh and healthy food available.

Two caveats: The abundance of food also includes an abundance of junk, and while there is plenty of healthy food, there also is a shortage of people who can access it.

According to data from the South Carolina Food Access Task Force and the U.S. Department of Agriculture, low-income neighborhoods in this state have about 25 percent fewer supermarkets than wealthier neighborhoods; and food shoppers in the state spend approximately $300 million in stores that are removed from the state’s food deserts, thus keeping investment in grocery stores out of reach for lower-income neighborhoods.

This translates into a higher propensity towards obesity and related health conditions in low-income residents, who often rely on fast food and less-healthy selections from dollar stores that set up close by.

The coronavirus pandemic bears out the danger of poor health. Most of the thousands of South Carolinians who have died from COVID-19 are older residents with preexisting health conditions. But younger deaths also are overwhelmingly tied to preexisting conditions, chiefly heart disease and diabetes, according to regularly refreshed statistics from the South Carolina Department of Health and Environmental Control (DHEC).

Given that conditions like hypertension, arteriosclerosis, and diabetes are frequent offshoots of obesity, it might be tempting to equate the impact of diet with resilience against COVID. True, the virus has done disproportionally more damage in the state’s communities of color and in lower-income communities (where residents are disproportionately affected by chronic health conditions). And, true, there are a lot of correlations between A) communities of color and low-income neighborhoods and B) low-income neighborhoods and food deserts.

But it’s important to remember that correlation does not equal causation. It’s also important to remember that health and nutrition are, as Dr. Jessie Hoffman, a nutritionist and professor at Winthrop University, says, “the long game.” So while good health has seemed to keep the worst of COVID-19 away from most people who’ve contracted it, it’s a little too simplistic and hopeful to think that swapping a bag of chips for a nice salad with balsamic vinaigrette will save you.

Food Access and Dollar Stores

The areas in red are South Carolina's food deserts. Notice how they concentrate in cities, where food is abundant, but access to healthy food is limited.
Credit South Carolina Department of Health and Environmental Control

You can’t discuss access to unhealthy food without at least mentioning race. If your neighborhood is mainly Black, lower-income or not, there most likely are a lot more fast-food restaurants close to your home than you’d find in predominantly white neighborhoods, according to the National institutes of Health.

Then there’s the problem of dollar stores. Dollar stores are ubiquitous in poor neighborhoods and rural towns. Often, these stores are the closest thing to a supermarket residents have.

“Their access to food might be Dollar General because it’s right there,” says Shanna Sykes of the Rural Health and Nutrition Program Team at Clemson University’s Health Extension. “And you know if you’ve ever been in Dollar General, they don’t offer a lot of healthy varieties of food.”

A June, 2020, report by ProPublica paints a dark picture of how dollar stores affect neighborhoods. Along with reported issues of crime and violence, there is a look at how dollar stores often position themselves as a solution to the problem of food deserts and yet often end up exacerbating that very problem.

Dollar stores have plenty of packaged foods and snacks and cans of salty soups and ravioli.

“What they’re lacking is … fresh fruits and vegetables,” Sykes says. “DHEC tried to work with Dollar General to get produce in there – and not just put it in, but put it by the check-out … where the candy bars are.”

In an email, DHEC stated:

“The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) serves to safeguard the health of low-income pregnant, postpartum, and breastfeeding women, infants, and children up to age five who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating including breastfeeding promotion and support, and referrals to health care. Through the work of the program’s Vendor Management Unit, WIC has nutritious foods available for its participants in various stores statewide. 

"To date, Dollar General has not applied and is not a WIC- authorized vendor.  South Carolina authorizes vendors continuously to ensure participants can receive the services needed. There are currently more than 600 authorized vendors who are committed to providing excellent service to our current participants at the lowest possible cost.

"Visit the website to learn more on how a store can become a WIC-authorized vendor.”

According to the CDC, only one in 10 adults in the U.S. eats enough fruits and vegetables. And while access is a major isue, most health experts are aware that they also need to convince people to actually eat healthier foods.

Dr. Hoffman says it would be a good idea to teach scientists how to get that point across while they're still in grad school.

"It's on us as scientists to do a better job at disseminating information," she says. "Not so much dumbing it down, but pulling it apart and translating it into a language that is understadable to the public. It should be a course [science] students take in how you're transmitting your information to the public, but it's not." 

The Long Game and Food Privilege

Nutrition, says Dr. Hoffman, yields its benefits over time. Someone who had a poor diet (and poor health linked to that diet) before the pandemic cannot just trade junk food for health food and expect to be fully armored against a virus.

Rather, she says, a good diet that contributes to good health is a lifestyle that, if already in place, is likely to do better against illness in general. She does advocate that people eat as healthy as they can, which she says should include a hearty nod to gut health.

“A large portion of our immune system does reside within out gut,” she says. “And you can support your gut by eating lots of fiber, which is found in fruits, vegetables, and whole grains. It’s not just a safety net like, ‘Maybe this will help with COVID.’ This is well-studied to help with cardiovascular disease; this is well-studied to help with incidence of Type-II diabetes; this is well-studied to help with overall metabolic health.”

But Hoffman understands the conditionality of that sentiment and cautions those of us fortunate enough to have access to real food not to ignore our privilege.

Vitamin D became a hot commodity when news broke that it could help build a defense against COVID-19. So why doesn't everyone go get a bottle of Vitamin D supplements? For the same reason that not everyone can buy organic, free-range groceries.
Credit Michele Blackwell / Unsplash

“We have to be realistic in understanding that it’s very privileged for us to say, ‘Just eat a more anti-inflammatory diet; maybe buy a Vitamin D supplement,’” she says. “[A lot of] people don’t currently have the means to do that.”

The Pressure on Food Banks

Hoffman’s acknowledgement of food privilege was part of a discussion about food pantries, which have come under increasing pressure to be a main outlet for healthy meals.

“Our food banks and food pantries right now are struggling because there’s such high demand,” she says.

Winthrop has its own small food pantry stocked mostly with donated foods, but it has the same limitation a lot of food pantries have.

“With a food pantry, and even some food banks,” she says, “you can’t keep a lot of fresh produce, so it tends to be a lot of packaged things.”

A sharp uptick in income loss over the course of the pandemic has led to greater food insecurity and more pressure on food banks – which typically have more elaborate and well-stocked operations that food pantries.

“[Our] volume is up 50 or 60 percent, in terms of the number of people we’re serving because of the pandemic,” says Mike Darrow, executive director of Feeding the Carolinas. “People have lost their jobs, hours cut. They don’t know how they’re going to pay for either food or medicine, so they’re coming to us.”

A good third of the new people Feeding the Carolinas is seeing at its 10 food bank locations in the Carolinas and Georgia, Darrow says, are people who’d never visited any food bank before the pandemic.

But volume is not all that’s straining these places. Feeding the Carolinas partners with hundreds of agencies to help get food to people in soup kitchens and food pantries, but those are often staffed by volunteers who usually are retired residents.

Before the pandemic, that was not a big deal, but considering how dangerous the coronavirus has been to people over 65, these outlets have been left grossly understaffed.

“We saw 20 to 30 percent of our partner agencies close down or limit their hours to protect themselves,” Darrow says. “We’ve had to step in and do what we call ‘mobile distributions.’”

Mobile distributions are what you’d see following a disaster like a hurricane. Volunteers would make food boxes for families and set up a temporary distribution site in a parking lot in a community.

The logistics to put up these sites were familiar when COVID hit, Darrow says. The longevity was not. Mobile distribution sites are meant to be temporary, not dragged indefinitely along with a pandemic that’s taken away a whole year of people’s lives (so far).

Let’s Not Forget the Children (and Moms)

When looking at food insecurity through the prism of the coronavirus pandemic, the effects of the outbreak on children can get overlooked. The virus’ direct effect on children has been statistically small compared to its effect on older adults. There have been COVID-related deaths and severe illnesses in children, but to nowhere near the magnitude as for people over 65.

But COVID’s reach is more than just its infectious nature.

The numbers on these maps show what hunger in South Carolina was like before the pandemic. The pandemic has made things worse.
Credit Feeding America

“The pandemic has truly created a public health issue when it comes to food insecurity regarding school-aged kids,” says Dr. Lakesia Tucker, a professor of social work at South Carolina State University and acting chair of university’s Department of Human Services. And even this has more to it than it might seem.

Children from lower-income homes usually rely on their schools for food. All public schools in the state participate in the National School Lunch Program, and through it, South Carolina schools have been able to offer free and reduced-cost meals. Some schools also provide breakfast, and 153 schools in 28 counties (including private and charter schools) participate in the Fresh Fruit and Vegetable Program.

That all translates into tens of millions of meals in the course of a school year, but the catch is, school takes breaks for spring, summer, winter, and long weekends.

The state Department of Education and the state Department of Agriculture do fund the Summer Food Service Program (SFSP) to fill the long months when children cannot rely on school cafeterias for meals. But COVID has left the SFSP with the same problem food banks have had to contend with – the program needs volunteers, many of whom are older and, therefore, more vulnerable to the coronavirus.  

And hunger in children isn’t just about the stomachache of not getting enough to eat.

“Food insecurity does impact academics, behavior, as well as attendance if [chidren] are in school,” Dr. Tucker says. “So it’s definitely important that we take a look at, how do we continue to allow students to have access to foods?”

An added wrinkle is that a lot of kids are not physically in school right now. Schools around the state have routinely closed buildings because of a COVID flare-up, and some parents are simply not comfortable with sending their kids into a building full of people during a viral outbreak (despite that the CDC now advocates schools be open to in-person learning); most districts are offering hybrid and staggered schedules that are partly online and partly in-person.

And while school districts have continued providing meals – alongside trying to find the best way to provide a safe environment for education – it’s not as easy for school children to get to those meals when they’re not in the building where they’re served.

What hurts Dr. Tucker to know is that the solution to empty bellies is usually the same one for kids as it is for grownups who don’t have a lot of money – convenience stores and dollar stores.

“Because we’re in the pandemic, families are just trying to survive by any means necessary,” she says. “If that means they have to purchase those foods from somewhere other than a grocery store … that’s what they’re going to do.”

Families receiving help through the Supplemental Nutrition Assistance program, or SNAP, are expected to

Lower-income residents have more fast-food restaurants near them than supermarkets, much of the time. That can make for poor health when fast-food becomes the main piece of a diet.
Credit Scott Morgan / South Carolina Public Radio

see a 15 percent bump in benefits for six months, beginning in March; and there is a push by the Biden administration to increase funding to strained food banks and school meals programs.

But South Carolina remains a hungry state. According to Feeding America, nearly 12 percent of state residents were food-insecure when the numbers were last calculated, in 2018. If you factor in only children, that number shoots up past 16 percent. Both averages are slightly above the national, and there are six counties in South Carolina – Marlboro, Dillon, McCormick, Barnwell, Bamberg, and Allendale – where the percentage of food-insecure children is above 25.

And those numbers are from 2018, before the pandemic disrupted meal programs and overstressed food banks.

Something else to keep in mind is that food insecurity is often a gender issue. A 2019 report on household food insecurity by the USDA shows that single-family homes are much more like to experience poverty and food insecurity, and when the single parent is the mother, the problem is exacerbated further still.

And the Food Research and Action Center, a Washington, D.C.-based organization, reports that food-insecure women are at higher risk for obesity and other diet-driven health problems. They are eating, the FRAC states. They are just eating foods that are unhealthy.

Solutions

Leaving aside the issue of food insecurity for just a moment, the World Health Organization recommends taking your nutrition seriously in the face of COVID. Among the WHO’s recommendations, as disseminated through its Mediterranean Regional Office: eat as much fresh and unprocessed food as possible; limit oils, salt, and sugars; and drink plenty of water to “significantly lower your risk of overweight, obesity, heart disease, stroke, diabetes and certain types of cancer.”

In other words, the exact conditions COVID preys upon most. Even if it’s still too early to really know anything about the relationship between COVID and diet, the WHO recommends as healthy a diet as possible as protection against disease.

“If you’re underfed, your immune system is not going to function properly,” says Dr. Hoffman. “You’re going to be more susceptible to infection.”

Getting back to food insecurity, public health and social program experts will admit that it’s a lot easier to say “eat well” than it is for some people to do it.

While some, like Dr. Tucker, strongly advocate for increased SNAP benefits and expanded food programs for low-income families, everyone involved in the effort to feed hungry South Carolinians says that part of the solution involves conversation and education.

“When the pandemic is over, people are going to continue to need access to food,” Dr. Tucker says. “So how do we do that? We definitely have to start the conversation; we have to do more research in that area; continue to speak to our public officials about having access to food for low-income families; the areas in which we put convenience stores, put grocery stores in, because we still need to have access to food and the ability to purchase that food.”

For Mike Darrow of Feeding the Carolinas, education at the food bank level is key.

“Understanding how to prepare food and understanding what is ‘good food’ is very important,” Darrow says.

One of the encouraging things about healthy meal prep is that a lot of the most healthy foods, like greens, grains, beans, and stew vegetables are not expensive and can be made in batch sizes that yield lots of freezable leftovers for future meals.

One of the discouraging things is that a lot of fruits and vegetables are unfamiliar to a lot of people, so they don’t eat many of the most healthy foods because they don’t know what to do with them. (Visit this report from South Carolina Public Radio for more on that.)

“At our food banks, we’re not just about quantity at all, we’re about nutritious food,” Darrow says. “So we will have nutritionists on staff or tap into local experts and do cooking classes. We’ll share recipes or try to [explain], ‘This is how you prepare a meal, this is how you use this type of produce.’”

But even a good course in healthy cooking can’t compete with a lurking problem many lower-income families have – lack of time. Single-parent households in particular are usually overstressed for time and resources, and it’s simply not possible to always be able to prepare meals for the days ahead. So hunger advocates say that we need to guard against assuming that everyone is able to put cooking lessons to regular use.

But, another encouraging thing is that eating healthy doesn’t mean that you have to shell out for an all-organic, free-range diet. Dr. Hoffman says that families can learn to shop for nutritionally sound foods that won’t break their bank accounts.

“It’s [incorrect] to say that processed food is bad,” she says. “Canned foods, frozen foods, foods that we would consider more processed can have a lot of benefits nutritionally. So it’s not like you have to shop at Whole Foods and buy all organic food to reap the benefits of eating nutritionally healthy.”

The trick, of course, is to learn what kinds of packaged foods are good to eat and which will contribute to that slate of illnesses that a disease like COVID attacks so aggressively.

  • For a list of food pantries and subsidized groceries in South Carolina, visit FoodPantries.org at this link.
  • For information on initiatives to address food access in South Carolina, visit the SC Food Access Task Force.
  • If you’re interested in starting a mobile meals program, visit No Hungry Kid.
  • For a look at how the South Carolina National Guard is helping, check out this story from the [Greenwood] Index-Journal.
  • To learn more about food and nutrition programs in the state, visit the South Carolina Department of Social Services.
  • To help sponsor a state Department of Education Summer Food Service Program that helps feed school-age children, visit here.
  • You an also check out any of the organizations mentioned or linked in this story, and contact your state senator or representative to discuss hunger initiatives in South carolina. Find them here.

For more  from South Carolina Public Radio on the kinds of topics discussed in this article, including links to food initiatives, visit here (for a fresh produce initiative in Marlboro County) and here (for a look at the early effects of the pandemic on Rock Hill’s homeless centers) and here (for a look at how food banks in the Upstate and Piedmont had to readjust and restructure in the face of the pandemic.

Scott Morgan is the Upstate multimedia reporter for South Carolina Public Radio. Follow Scott on Twitter @ByScottMorgan.

Follow South Carolina Public Radio @SCPublicRadio and on Facebook.