Abstract
High rates of chronic diseases and increasing nutritional polarization between different income groups in the United States are issues of concern to policymakers and public health officials. Spatial differences in access to food are mainly blamed as the cause for these nutritional inequalities. This study first detected hot and cold spots of food providers in West Virginia and then used those places in a quasi-experimental method (entropy balancing) to study the effects of those places on diabetes and obesity rates. We found that although hot spots have lower rates of chronic diseases than non-hot spots and cold spots have higher rates of chronic diseases than non-cold spots—the situation is complicated. With the findings of income induced chronic disease rates in urban areas, where most hot spots are located, there is evidence of another case for "food swamps." However, in cold spots which are located mainly in rural areas, higher rates of chronic diseases are attributed to a combination of access to food providers along with lacking the means (i.e., income for low-income households) to form healthier habits.
Highlights
Poor diet is a modifiable risk factor for obesity and diabetes
The weights are incorporated in Equation (5) as a survey weight: Yi = β 0 + xi β + ei where Yi is the rate of diabetes or obesity; and xi is a set of independent variables that includes whether a census tract is considered in treatment, an urban versus rural designation for each census tract, mean household income, and the proportions of the population that are employed in the sectors of agriculture, fisheries, hunting, and mining (AFHM)
When we compare the realizations of the pre-treatment characteristics of the hot spots and cold spots to those of the control group, the results reveal the efficacy of entropy balancing
Summary
Poor diet is a modifiable risk factor for obesity and diabetes. Contributing to substandard nutrition, the food environment is thought to be a primary driver of poor diet. Food swamps are areas with a higher number of unhealthy vendors, such as convenience stores and fast food restaurants [10] Despite this surge of researchers, most studies still failed to prove the causal claim that underserved areas are associated with an increased risk of chronic diseases, with few exceptions [8,10]. We explicitly account for spatial drivers that may influence the supply of food vendors and study how these places might impact diabetes and obesity rates in West Virginia. This state is an interesting case to study. The remainder of the article is organized as follows: in Section 2, a literature review on chronic diseases and place-based policies is elaborated; Section 3 explains the methods and the data used in this study; Section 4 presents the results; Section 5 provides some discussion and policy implications; Section 6 discusses about the limitations of this research
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