Advice about healthy eating often focuses on individual choices: Buy more vegetables. Cook at home. Plan ahead. But those recommendations can be much harder to follow when a full-service grocery store is difficult to reach and fast-food restaurants or convenience stores are far easier to find.
A new longitudinal study from American Cancer Society researchers examined how neighborhood food environments changed across the United States between 2003 and 2023. The researchers mapped licensed food retailers at the census-tract level and estimated the share of neighborhoods that could be classified as food deserts or food swamps.
The study, published in the American Journal of Public Health, did not measure what individual residents bought or ate. It also did not examine whether living in a particular neighborhood directly caused cancer, obesity or other health outcomes. Instead, it offers a broader look at the options people encounter when they try to shop for food.
Food deserts are generally areas where access to grocery stores is limited. Food swamps present a different challenge: Food is available, but restaurants and fast-food locations dominate the surrounding food environment.
Using a distance-based measure that looked at food retailers within a half-mile of census-tract borders, the researchers found that the percentage of tracts categorized as food swamps increased from 80.2% in 2003 to 88.5% in 2023.
The percentage classified as food deserts declined only slightly over the same period, from 6.1% to 5.5%.
“Unfortunately, our findings show many neighborhoods where healthy food options, especially fresh fruits and vegetables, are almost nonexistent, and fast-food restaurants and corner stores with only a few healthy options are dominating the landscape in these same neighborhoods,” said Dr. Daniel Wiese, lead author of the study and a principal scientist in cancer disparity research at the American Cancer Society. “This needs to change.”
The findings do not mean that nearly nine in 10 Americans lack access to nutritious food. The researchers measured census tracts, not individual households, and the food-swamp category reflects the balance of nearby food retailers. A neighborhood may still contain a grocery store while also having a much larger number of restaurants or fast-food outlets.
The study also found that food deserts remained more common in rural communities and areas experiencing persistent poverty. Transportation made a meaningful difference. When the researchers estimated grocery-store access for people relying only on public transit, more than 7.4 million Americans would be living in food deserts.
Food access is only one piece of a much larger picture. Prices, household income, available time, cooking facilities, food preferences and store quality can all shape what people eat. Grocery delivery and the ability to shop outside a person’s immediate neighborhood may also affect the options available to individual families.
Still, the findings offer a useful reminder: Healthy eating is not simply a matter of knowledge or willpower. The choices people make are influenced by the choices that are realistically available to them.
The researchers are employed by the American Cancer Society, which receives grants from private and corporate foundations, including foundations associated with companies in the health sector, for research outside the submitted work.