Access to healthy, fresh and affordable foods is elusive for millions who live in rural America

(InvestigateTV) – Even in the best of times, millions of Americans struggle to put food on the table.

They don’t earn enough money to pay bills and regularly feed themselves and their families. They live in areas where grocery stores are few and far. Some don’t have cars, and rural America is largely void of public transportation. Others struggle to make ends meet even with government assistance and food banks.

When the COVID-19 pandemic hit, millions more suddenly had to make a difficult choice that others make every day: bills or groceries?

Before last year, food insecurity impacted about 10.5% of U.S. residents. Once the pandemic largely shuttered the economy, experts estimate the percentage of people who were food insecure at least doubled, impacting 66 million adults and children from coast to coast.

People who are food insecure do not have enough resources to sustain a healthy diet and lifestyle. The lack of consistent access to fresh produce, meat and dairy can lead to – or exacerbate – diabetes, heart disease, obesity and a myriad of other illnesses and diseases.

For some residents of rural America – particularly in the Appalachian and Mississippi Delta regions – the situation is even bleaker.

Many live in food deserts where grocery stores that offer wide varieties of affordable fruits, vegetables, meat, and dairy are at least 10 miles away from home. Nearly 2 million households in Appalachia and the Delta rely on the Supplemental Nutritional Assistance Program, commonly called food stamps, which provides them about $6 a day for each person on the plan.

“I’ve gone without food before,” said Breanna Talbert, who relies on her monthly SNAP benefits to feed her family.

The exact, current state of food insecurity is largely unknown because federal data on the issue lags, sometimes by years. But an InvestigateTV analysis of the data available before the pandemic paints troubling trends:

· In 2015, the most recent U.S. Department of Agriculture data showed that more than 7.1 million people in Appalachia and the Delta had low access to healthy foods, representing about 20% of the population of those two regions.

· The most food insecure Americans lived in the Delta region of Mississippi, with three of its counties leading the nation with the highest percentage of residents without consistent access to enough food to sustain a healthy lifestyle. These counties also were among the poorest in the nation, with at least 30% of households living in poverty.

· Overall, in 615 of the 662 Appalachian or Delta counties, the percentage of residents who were food insecure exceeded the national average in 2017.

“Food insecurity manifests itself in a variety of negative health outcomes affecting children as well as adults and seniors,” said James Ziliak, an economist and founder of the Center for Poverty Research at the University of Kentucky, where he also teaches. “We view it as a significant public health challenge in America.”

From food deserts in Kentucky to Mississippi and to kitchens such as Breanna Talbert’s in West Virginia, residents rely on neighbors, charities, gardens, and government assistance to feed their families. Even still, those efforts sometimes fall short.

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Where groceries are hard to come by

Many senior citizens in the rural, rugged Appalachian countryside of Robertson County, Kentucky look for Bill Robinson’s maroon van to pull up to their homes with his meal delivery.

Some are too crippled from arthritis to cook their own meals. Others don’t have a car to drive to the nearest grocery store about 25 miles away. Even Robinson, 74, depends on the meals to help stretch his food bill and avoid a 40-minute drive on the mountainous terrain to the grocery store.

“We’re kind of in the middle of nowhere here,” Robinson said.

In Robertson County, a quarter of the adults have diabetes, double the national average. Adults there also die there of heart diseases at a much higher rate than the rest of U.S. residents.

A healthy diet can help control or prevent both problems. But residents in Robertson live in a food desert.

The sole grocery store closed a few years ago, leaving residents with only a gas station convenience store and a dollar store.

The convenience store offers a smattering of fresh food, but its small selection of produce, ground beef and dairy products generally cost more than what is found in a grocery store or supermarket, InvestigateTV found.

A dozen eggs for example, cost $2.49 – more than a dollar higher than what can be found at a Wal-Mart in nearby counties.

At the dollar store, the only fresh offerings for shoppers include whole or 2% milk, eggs, prepackaged lunch meat, hotdogs, and cheese.

The USDA labels areas as food deserts if residents of rural communities live farther than 10 miles from a grocery store.

InvestigateTV used USDA data and extensive Internet research to isolate grocery stores and farmers markets that offer wide varieties of fresh food in the Appalachian and Delta regions from other kinds of stores that accept SNAP benefits as payment.

Of the 33,623 stores that accepted food stamps in December, InvestigateTV determined that about 80% were not the kinds of stores that residents could regularly rely on to meet daily nutritional meals and maintain a healthy diet:

About two-thirds of them were gas station convenience stores, dollar or discount stores, tobacco shops and liquor stores where fresh food is limited.
Another 13% were specialty stores that feature a single fresh product such as bakeries, butcher shops or seafood markets. These stores didn’t have large selections of the other important food groups, if any.
Six counties in the regions, including Robertson, don’t have a grocery store that accepts SNAP.
Another 137 only have one or two.
Issaquena County in Mississippi doesn’t have any stores that sell food to benefit recipients.

In Robertson County, some residents, such as Robinson, rely on state-run food safety nets, one of which provides residents with plants for a vegetable garden.

Each year, Robinson grows about 60 plants and harvests enough vegetables to last throughout the year.

“It helps a lot,” said Robinson, who, along with his wife live on a modest fixed income.

But he said it also is a lot of work to grow and maintain a garden and not everyone has the land or the physical health to do it.

In Robertson County, about 20% of residents are considered food insecure because they lack the resources – such as money or a car – – to regularly buy and consume healthy food.

In practical terms, Professor Ziliak said that could mean skipping meals, not filling a prescription, or ignoring a utility bill.

The lack of a grocery store also explains why federal data shows that about 70% residents of Robertson County had low access to healthy foods – among the highest percentage in Appalachia and the Delta.

“The central Appalachian region is very mountainous. It’s difficult terrain,” Ziliak said. “Which means acquiring food can oftentimes be a real challenge. While you may live relatively close to a convenience store that may have some foods, it’s not enough foods for a nutritious diet. Most of these households have to travel great distances, which can oftentimes be costly.”

‘When you can’t afford to eat healthy’

Brenda Collins knows all too well that a steady diet of canned green beans, frozen chicken nuggets, potato chips, sugary fruit juices don’t serve a body well.

As a nurse practitioner in the Delta’s Jefferson County, Mississippi, she treats patients who are obese, who are battling heart disease, who have diabetes. The kinds of processed foods that are largely available in Collins’ county can worsen already fragile bodies.

In Jefferson County, typical options found on most store shelves include those high sodium, high fat foods. Of the nine stores that accept food stamp benefits here, only one is a typical grocery store, federal data shows.

“Eating healthy, having good, fresh vegetables and adequate food is important,” Collins said. “If you can’t afford, and the nearest supermarket is either in town that has limited options or driving 30 miles minimum to get what you need, then you’re gonna go without.”

Every SNAP-participating store in Jefferson is clustered in its county seat of Fayette. But only about 20% of the county’s 7,225 residents live in Fayette.

“We don’t have a lot of options,” Collins said. “We don’t have whole food stores. We don’t have fresh vegetables. There’s a need. Eating healthy is important.”

In 2015, the Centers for Disease Control and Prevention labeled a large swath of the eastern side of the country as the “Diabetes Belt.” It encompasses most of the Appalachian and Delta regions.

In two-thirds of the 662 counties in the regions, the percent of their adult residents with diabetes exceeds the national average.

“When you can’t afford to eat healthy and eating healthy is expensive, then you eat what you can and fast food is what you can get,” she said.

Collins and her husband Tracy are trying to change habits.

She runs a program to teach families how to prepare low-sodium meals, how to grow their own fruits and vegetables and what foods offer the most nutritional value.

“I think it’s important to provide education resources to families,” Collins said.

For the past 14 years, she and her husband, a pastor, have taken children on summer camping trips for five days to expose them to nature and provide them with nutritional meals, and, hopefully, to teach them at a young age of the value of a proper diet.

“Sometimes people don’t see the effects of things until it’s too late,” Collins said. “Once we start offering more programs and more opportunities for people to get healthy, I think they’ll come. . . They just have to have the opportunity.”

How families survive on food stamps

Before COVID-19, about 12% of all households in the U.S. relied on the food stamps to make ends meet.

Breanna Talbert in Wirt County, West Virginia was among them.

The 39-year-old mother of a 13-year-old daughter struggled to make her $346 monthly benefit stretch from the first to the 31st.

“There was a lot of ramen (noodles), macaroni and cheese, stuff that was cheap,” she said.

Fresh fruits, vegetables and chicken were a rare treat for the family. Sometimes, with her monthly benefit depleted, she went without so her kids could eat.

The amount of money individuals and families receive in food stamps largely has held constant since the program’s inception in the 1960s when inflation is factored, said Ziliak, the poverty researcher at the University of Kentucky.

For example, when adjusted for inflation, a family of four living in the continental U.S. received less in SNAP benefits in 2019 than they did in 2000 – $642 vs. $647 a decade ago. (Alaska and Hawaii receive slightly more.)

“The key word is supplemental. It’s not designed to cover your full budget,” Ziliak said. “It’s designed to fill some of the food budget.”

In 2019, a family of four had at most $21.40 a day for food.

Before the pandemic, only about 40% of all SNAP recipients received the maximum allowance. Income from work or Social Security reduced the amount of food stamps a family or individual received.

Across the Appalachian and Delta regions, an estimated 15% of all households received SNAP benefits, Census data shows, which was slightly higher than the national estimate.

But in some of the poorest counties, the percentage of households receiving food stamps is double the national average:

In Owsley County, Kentucky, 39.4% of households receive SNAP benefits. Their median household income is estimated at $14,303 – almost four times less than the national median income of $51,758.
In Green County, Alabama has the highest percentage of households receiving SNAP in the Delta at 38.9%. Those households have a median income of $10,972 – nearly five times less than the national average.
In Lee County, Arkansas and Sumter County, Alabama, where about a quarter of households rely on SNAP, their median incomes are less than $10,000. And, in both counties, 93% of all the SNAP households held jobs in the previous 12 months.

For almost all Americans receiving food stamps, the benefit doesn’t cover a cost of a meal in their respective counties, according to a 2018 study by the Urban Institute, a nonpartisan think tank in Washington, D.C.

The study showed that on average a single meal costs $2.36 but SNAP recipients receive at most $1.86 per meal.

An InvestigateTV analysis of the data shows that in all but 24 counties in the United States – out of more than 3,100 counties – food stamp benefits don’t cover the cost of a meal for most people.

In every county in the Appalachian and Delta regions, a meal costs more than the benefits.

For example, in Lafayette County, Mississippi, the cost of a single meal there is 35% more than the maximum amount for food stamps, the Urban Institute’s data shows.

In Wirt County, West Virginia, Breanna Talbert has had to be mindful of where she shopped. At the two grocery stores in town, food cost more than at the supermarkets 30 miles away.

Why the pandemic has helped some struggling families

The images of long, persistent lines at food pantries during the pandemic prompted Congress to increase food stamp benefits for everyone by 15% and to give each recipient the maximum amount.

For Talbert that has meant ditching ramen noodles and low-end ground beef for chicken, pork chops and fresh produce.

“Now my fridge is full,” she said. “It’s not like I’m going out and buying steaks or anything. I was able to go to Sam’s (Club) the other day and buy six packs of chicken breasts for $1.99 each. They were on sale there, and I wouldn’t have been able to do that before.”

Those increased benefits, however, are set to retire in the fall.

Advocates and researchers such as Ziliak say those changes should be made permanent to help ease the food insecurity problems facing so many Americans and ultimately to help boost health outcomes.

Talbert agrees.

“My daughter loves asparagus. I can buy my daughter asparagus whenever she wants it. And it’s a good feeling,” she said. Before, “there was no way I could have bought asparagus.”

But if the food stamp benefits return to 2019 levels, asparagus – a vitamin packed vegetable that helps with maintaining healthy weight, improving digestion, and lowering blood pressure – will again become a rare treat in the Talbert household.