Rural Hunger and Access to Healthy Food
Access to healthy and affordable food can be a challenge for rural residents, regardless of income level. Due to economic factors such as a low volume of consumers, many rural areas lack food retailers and could be considered food deserts - or areas where there is limited availability of fresh, affordable foods. Rural shoppers may rely on more expensive and less nutritious options, such as those available at a gas station convenience store, or face a long drive to a town with a grocery store that stocks fresh produce, milk, eggs, and other staples. Ironically, the rural areas where food is grown can often be areas where residents have limited access to nutritious food options.
Some rural residents and households are food insecure. Household food security means that there is reliable access to a sufficient amount of affordable and nutritious food for all members of the household at all times for an active and healthy life.
Food security can also be looked at as a community-level issue. According to a publication of the USDA Economic Research Service, community food security:
"…concerns the underlying social, economic, and institutional factors within a community that affect the quantity and quality of available food and its affordability or price relative to the sufficiency of financial resources available to acquire it."
In rural areas, access to food may be restricted by a lack of economic resources or other factors, such as transportation challenges. Over time, food insecurity can negatively affect learning, development, productivity, physical and mental health, and family life.
According to the United States Department of Agriculture report, Household Food Security in the United States in 2016, 12.3% of U.S. households were food insecure at least some time during the year. The prevalence of food insecurity was higher in rural areas than metropolitan areas.
Source: Household Food Security in the United States in 2016, page 14.
The following map from the USDA Food Environment Atlas shows the percentage of the population with low income and low access to a store in 2010.
This topic guide provides information for healthcare providers, human service providers and organizations wishing to address food security in rural communities. The guide covers:
- How to learn about rural food security in your community
- Strategies rural communities and healthcare providers can use to address rural hunger
- Funding and assistance programs to address food access and nutrition
Frequently Asked Questions
- How can we assess the level of food security and availability of healthy food in our rural community?
- What are food deserts and why do they exist in rural areas?
- What are strategies that rural communities have used to improve access to healthy and affordable food?
- How can rural healthcare organizations work to address food and nutrition issues in their community?
- How widely used are federal nutrition programs among rural families?
- What are some nutrition programs for children available in rural schools, day care centers, and other settings?
- What are some food assistance programs for seniors, such as home meal deliveries, in rural communities?
- Is there a relationship between rural food insecurity and health outcomes?
- What are some funding opportunities for rural community food pantries?
How can we assess the level of food security and availability of healthy food in our rural community?
Community-based strategies can be used to improve access to healthy food for all members of the community. The first step in developing a strategy is to assess the level of food security and availability of food in the community.
The Community Food Security Assessment Toolkit was developed by the U.S. Department of Agriculture (USDA) to help local government officials, local organizations, and community planners assess the level of community food security. The toolkit looks at six components of community food security:
- Community socioeconomic and demographic characteristics
- Community food resources
- Household food security
- Access to food
- Food availability and affordability
- Community food production resources
The tool is intended to help communities move to a higher level of food security for all households.
The USDA Food Access Research Atlas is a mapping tool that provides information on food access by census tract. The mapping tool uses the following indicators regarding access to food:
- Distance to a store with healthy food or the number of stores in an area
- Motor vehicle access
- Low-income areas
- High levels of group quarters, which might indicate institutions that provide food service
Also, the USDA Food Environment Atlas provides county-level data on a wider set of statistics regarding food choices, health, and community characteristics. The Food Environment Atlas has maps showing the following factors, all of which influence the diet quality of individuals and communities:
- Access and proximity to a grocery store
- Store availability
- Restaurant availability
- Food assistance
- State food insecurity
- Food prices and taxes
- Local foods
- Health and physical activity
- Socioeconomic characteristics
What are food deserts and why do they exist in rural areas?
Food deserts are locations where access to healthy and affordable food is limited. According to the Centers for Disease Control and Prevention:
"Food deserts are areas that lack access to affordable fruits, vegetables, whole grains, lowfat milk, and other foods that make up the full range of a healthy diet."
Characteristics and Influential Factors of Food Deserts, from the USDA’s Economic Research Service, reports that characteristics of a food desert include a low-income population, limited transportation options, and few grocery store options.
Food deserts typically exist in rural areas for economic reasons, such as low-income populations, and because rural areas often lack an adequate population base to support a grocery store that carries a variety of affordable and healthy food. Also, many rural residents do not have access to reliable transportation, which can make getting to a grocery store difficult. A 2009 article in the American Journal of Preventive Medicine discusses the impact that consolidation in the retail food industry has had on rural food access:
"…small town food stores, with limited floor space, economies of scale, and distance from distribution centers, continue to provide limited food selection at higher prices and face the persistent challenge to remain profitable… As a result, rural families with only convenience or small stores from which to choose experience higher prices and lower selection and quality of foods than those shopping in larger supermarkets."
What are strategies that rural communities have used to improve access to healthy and affordable food?
Food access is an important issue in rural communities across the country and many different approaches have been used to address the issue. The Healthy Food Access Portal can help communities find funding and resources related to retail projects and policy efforts.
Some strategies that can improve rural access to healthy and affordable food include:
Special Financing for Food Retailers
Some rural communities are able to offer subsidized financing for food retailers, often by taking advantage of federal and state programs. The Healthy Food Financing Initiative offers a range of programs through the USDA, the Treasury Department and the U.S. Department of Health and Human Services to improve access to healthy foods. This initiative helps bring grocery stores, small retailers, convenience stores and farmers markets to rural areas to increase access to nutritious foods.
Cooperative Grocery Stores
In order to improve access to food, some rural grocery stores have unique ownership models such as community-owned or cooperative models. The cooperative model has long been used in rural communities to provide key services, such as electricity and phone service, where distance and low volumes make providing that service unattractive and unsustainable for regular businesses.
This model has also served many rural communities well when it comes to operating grocery stores. Cooperatives are composed of members who are both customers and owners. The community-owned model closely resembles the cooperative model, although it is typically organized as a corporation, where community members can buy shares. For more information, see Rural Grocery Stores: Ownership Models that Work for Rural Communities.
Farmers markets can be organized in rural areas to help small local farmers financially, while also increasing access to fresh fruits and vegetables for local residents. However, it can be a challenge to establish a rural farmers market due to large geographic distances and the small number of potential shoppers. Attracting Vendors and Customers to Rural Farmers Markets offers suggestions on how to choose a location for a market and how to promote the market to farmers and consumers.
Both the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) encourage farmers markets to accept their program benefits. The Farmers Market Promotion Program (FMPP) is a USDA funding program which funds programs that increase the consumption of locally produced food.
Community-Supported Agriculture Programs
In community-supported agriculture programs (CSAs), local residents commit to purchasing part of a local farmer’s crop at the beginning of the year. Farmers receive a cash investment to operate their farm and residents receive a supply of fresh produce. This program allows farmers and consumers to share the risks and benefits of local farming.
Farm-to-school initiatives help local farmers sell fresh fruits and vegetables directly to public schools or incorporate school gardens in meal programs so that nutritious meals and snacks can be served to students and teachers, as well as educating children about nutrition and local farming. The Center for Integrated Agricultural Systems offers toolkits and other resources related to farm-to-school initiatives. RHIhub’s Rural Schools and Health topic guide has more information about how schools can provide access to nutritious meals for their students.
Food pantries and other forms of direct food assistance, such as backpack food programs for children, can fill an important need for rural residents experiencing food insecurity. Food pantries can distribute nutritious food to low-income families as well as work with the local social services staff to educate families on nutrition, the Supplemental Nutrition Assistance Program, and other social services in the community. Mobile food pantry trucks may be an option in rural communities which lack a facility or place to store and distribute food. For example, the Care and Share Food Bank provides mobile food pantry services to rural communities across Southern Colorado.
Community Education and Outreach
Community programs to improve access to food also include education and outreach activities. Approaches to assist low-income residents include education on available food assistance programs, social services, and training related to home economics such as cooking from scratch and getting the most for your food dollar. The SNAP Ed program and Expanded Food and Nutrition Education Program (EFNEP) are federally funded programs that can provide education in communities. In addition, community organizations can start community gardens and teach individuals how to grow their own food to increase their self-sufficiency.
How can rural healthcare organizations work to address food and nutrition issues in their community?
Rural healthcare organizations can work with human services providers to ensure that low-income patients know how to enroll in food assistance programs in their communities. Human services organizations may be able to offer training and tools to primary care providers related to screening patients for food insecurity. Healthcare providers could make referrals for patients who need more assistance to:
- Human services agencies for food assistance programs
- Women, Infants, and Children (WIC) office
- Meal programs for seniors
- Local food pantries
In addition, rural healthcare providers can provide counseling and education for their patients and community members related to nutrition for health promotion and the management of chronic disease. Facilities may also partner with other organizations and businesses in the community to provide cooking classes, meal programs, and other nutrition-related services and education.
Healthcare providers can also "prescribe" healthy foods. Programs like the Wholesome Wave Fruit and Vegetable Prescription Program® can be used to increase the consumption of healthy foods by community members. See the Models and Innovations section of this topic guide for example projects conducted in rural communities.
How widely used are federal nutrition programs among rural families?
The Supplemental Nutrition Assistance Program (SNAP) is available through the USDA Food and Nutrition Service and helps low-income individuals and families purchase nutritious food. According to the ERS report, Alleviating Poverty in the United States: The Critical Role of SNAP Benefits, rural areas have a higher rate of poverty than metropolitan areas. Furthermore, child poverty is higher in rural areas. One of the key findings of the report is that:
"SNAP benefits reduced the depth and severity of poverty in both metropolitan areas and nonmetropolitan areas, with somewhat greater poverty reductions among individuals in nonmetropolitan areas."
The rate of SNAP usage is higher in rural areas than urban areas. Dynamics of Economic Well-Being: Participation in Government Programs, 2009-2012: Who Gets Assistance, a U.S. Census Bureau document, reports that average monthly SNAP participation rates in 2012 were 16.7% for nonmetropolitan areas, compared to 12.8% in metropolitan areas. According to the report, More Than One in Ten American Households Relies on Supplemental Nutrition Assistance Program Benefits, rural SNAP use is highest among black households (31%), compared to Hispanic (21%) and white households (11%). The report also states that many rural households that qualify for SNAP benefits are not enrolled in the program.
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is also available from the USDA Food and Nutrition Service. The WIC Program serves low-income women, infants, and children up to age five who are at nutritional risk. WIC provides nutritious food, information on healthy eating, education on breastfeeding, and referrals to healthcare. According to the 2010 document, Federal Child Nutrition Programs are Important to Rural Households, the percentage of households with a mother or child participating in the WIC program is higher in rural areas (9.4%) than in suburban areas (4.3%) or a central city (9.2%).
What are some nutrition programs for children available in rural schools, day care centers, and other settings?
There are many nutrition programs available for rural children, including the following:
- School Breakfast Program
- National School Lunch Program
- Special Milk Program
- Child and Adult Care Food Program: Afterschool Program
- Summer Food Service Program
RHIhub’s Rural Schools and Health topic guide has more information about these programs.
The Child and Adult Care Food Program (CACFP) provides financial assistance to child care centers for nutritious meals and snacks. The program helps in-home day care providers, day care centers, afterschool programs, and emergency shelters improve access to healthy food. Their website also provides nutrition education, healthy recipes, and wellness resources.
One barrier for eligible rural families to participate in the Child and Adult Care Food Program is that rural children are more likely to receive care in a relatives’ home than in a day care center or afterschool program which qualifies for the Child and Adult Care Food Program. Other challenges to increasing enrollment in child nutrition programs for eligible rural families include a lack of awareness about existing programs as well as a stigma related to receiving government assistance.
What are some food assistance programs for seniors, such as home meal deliveries, in rural communities?
Nutrition Services programs funded through the Administration on Aging provide access to nutritious meals, education, and nutrition counseling for adults age 60 and above, particularly those who have social and economic need. Programs vary depending on the needs and the resources available in each community.
Congregate meal programs offer meals in a central setting, such as a senior center. Home-delivered meal programs, such as Meals on Wheels, bring meals to the homes of frail, homebound or isolated older adults. Providing hot home-delivered meals to older adults living in remote rural communities can be a challenge due to travel distance and time required for delivery. In some locations, frozen meals or sack lunches can be delivered on a less frequent basis or picked up from a designated location. Often there is a suggested donation or sliding fee schedule to defray the cost of meals.
The Child & Adult Day Care Food Program (CACFP) is a federal program that provides healthy meals and snacks to adults receiving day care. Adult day care centers receive payments for serving healthy meals to adults who are 60 or older, or who are physically or mentally impaired to a level that limits their independence.
The Senior Farmers’ Market Nutrition Program (SFMNP) is offered through the USDA Food and Nutrition Service to provide low-income seniors with coupons that can be used at farmers markets, roadside food stands, and community-supported agriculture programs to promote the consumption of fresh fruits and vegetables among seniors.
The National Association of Area Agencies on Aging (n4a) has more information about home and community-based services available to seniors.
Is there a relationship between rural food insecurity and health outcomes?
Food insecurity affects an individual’s health in many ways. There has been significant research that shows that access to nutritious and affordable food for rural residents is important for improving health behaviors and status. Chapter 8 of the National Research Council’s Research Opportunities Concerning the Causes and Consequences of Child Food Insecurity and Hunger: A Workshop Summary discusses the available literature related to the health of children and pregnant women, which shows that food insecurity and hunger adversely affect child development and academic performance, and may contribute to behavioral health disorders and compromised immune systems, among other health issues.
According to the report, Patterns of Food Insecurity, Food Availability, and Health Outcomes among Rural and Urban Counties, the risk of food insecurity increases as counties become more rural. The highest food insecurity was found in rural areas of the East South Central census division. Results of the study show significant associations between food insecurity risk and the following:
- No leisure time physical activity
- Consuming less than five servings per day of fruits and vegetables
What are some funding opportunities for rural community food pantries?
To start a food pantry in a rural community, it is helpful to partner with a food bank because they can provide food at a lower cost. Food banks are storage and distribution centers that distribute food and other basic products to community or government agencies including food pantries and homeless shelters. Feeding America has information on how to find a local food bank.
Rural food pantries may receive donations from many sources. For example, in rural Wisconsin, the Community Center of Hope food pantry receives donations from local businesses, churches, and other community service groups.
The Emergency Food Assistance Program (TEFAP) is a federal program that makes food available to State Distributing Agencies, which then is provided to food banks and other local organizations.
Last Reviewed: 8/4/2015