Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.
Department of Geography, John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, USA.
Am J Clin Nutr. 2022 Apr 1;115(4):1027-1038. doi: 10.1093/ajcn/nqab380.
The food system is a social determinant of health and a leverage point for reducing diet-related racial inequities. Yet, food system interventions have not resulted in sustained improvement in dietary outcomes for underrepresented minorities living in neighborhoods with a history of disinvestment. Research is needed to illuminate the dynamics structuring food systems in racialized neighborhoods to inform intervention development.
To conduct participatory research examining the complexity and inequity of food systems in historically redlined neighborhoods to identify feedback mechanisms to leverage in efforts to transform system outcomes for racial equity.
We conducted a mixed-methods study in Cleveland, Ohio, USA from 2018 to 2021 using participatory system dynamic modeling with 30 academic and community partners, in-depth qualitative interviews with 22 key stakeholders, and public convenings with 250 local food policy council affiliates. Data were synthesized into causal loop diagrams depicting feedback mechanisms reinforcing or balancing neighborhood-level food system dynamics.
We identified 10 feedback mechanisms structuring nutrition equity, which was identified as a meta-goal for food systems in racialized neighborhoods. Feedback mechanisms were organized in 3 domains: 1) meeting basic food needs with dignity (i.e., side hustle, government benefits, emergency food assistance, stigma, and stereotypes); 2) local food supply and demand dynamics (i.e., healthy food retail, job security, food culture, and norms); and 3) community empowerment and food sovereignty (i.e., community power, urban agriculture, risk of gentrification). Five exogenous factors moderate feedback dynamics: neighborhood crisis, neighborhood investments, household costs, government benefit funding, and voter participation.
We identified nutrition equity as an overarching goal for local food systems, which reflects a state of having freedom, agency, and dignity in food traditions resulting in people and communities healthy in body, mind, and spirit. It is a transformative goal designed to spur system-level interventions that further racial equity through improved local food system dynamics.
食品系统是健康的社会决定因素，也是减少与饮食相关的种族不平等的着力点。然而，食品系统干预措施并未导致代表性不足的少数群体在历史上投资不足的社区中的饮食结果持续改善。需要研究阐明构建种族化社区食品系统的动态结构，以为干预措施的制定提供信息。
开展参与式研究，以考察历史上被红线划定的社区食品系统的复杂性和不平等性，以确定反馈机制，以便在努力改变系统结果以实现种族公平方面发挥作用。
我们在美国俄亥俄州克利夫兰市进行了一项混合方法研究，使用 30 名学术和社区合作伙伴的参与式系统动态建模、22 名关键利益相关者的深入定性访谈以及 250 名当地食品政策委员会成员的公开集会，从 2018 年到 2021 年进行了研究。将数据综合成因果回路图，描述强化或平衡社区层面食品系统动态的反馈机制。
我们确定了 10 种塑造营养公平的反馈机制，营养公平被确定为种族化社区食品系统的元目标。反馈机制组织在 3 个领域：1）有尊严地满足基本食物需求（即兼职工作、政府福利、紧急食品援助、耻辱和刻板印象）；2）当地食品供需动态（即健康食品零售、工作保障、食品文化和规范）；3）社区赋权和粮食主权（即社区权力、城市农业、易受高档化影响的风险）。五个外生因素调节反馈动态：社区危机、社区投资、家庭成本、政府福利资金和选民参与。
我们确定营养公平是地方食品系统的总体目标，这反映了在食物传统中拥有自由、能动性和尊严的状态，从而使人们和社区在身体、精神和心灵上都健康。这是一个变革性的目标，旨在通过改善地方食品系统动态来进一步促进种族公平的系统层面干预。
