Studying the Relationships Between Food Acquisition and Health Outcomes During COVID-19

Background

Food insecurity is the lack of consistent access to food adequate to sustain a healthy and active lifestyle.

Figure 1 - Three-week average of COVID-19 cases in NYC

Food insecurity has been consistently associated with negative health outcomes, including diet-related diseases, mental health, and comorbities with COVID-19 (Gundersen & Ziliak, 2015; CDC COVID-19 Response Team, 2020).

Food secure NYC residents were also impacted by changes in food acquisition behavior by COVID-19. "NYC Food 20/20" (2020) reported the following impacts on food retail and services:

According to CUNY School of Public Health (2020) survey data, 54% of respondents reported having a less healthy diet than pre-pandemic. Lower income households also reported consuming more packaged food than higher income households, which has generally lower nutritional value than fresh foods.

Problem Statement

During the COVID-19 pandemic, vulnerable populations in NYC had excessive difficulty in safely obtaining affordable and nutritious food as typical avenues for food access were massively disrupted for sustained periods of time.

The public health dangers and policy responses to COVID-19 exacerbated inequitable food access, and thus disproportionately increased food acquisition patterns associated with negative health outcomes.

The authors sought to inform future food resiliency strategies in NYC by connecting mobility data to the existing scientific basis of associations between nutrition, food insecurity, and diet-related diseases.

Data

Mobility

5-year ACS

POI and weekly patterns to model food acquisition behaviors through aggregated food location visitations.

Demographic and socioeconomic attributes to identify subpopulations with similar characteristics.

Methodology

Results

Figure 3 - Clustered CBGs on the map (excluded CBGs with population under 10)

• In the immediate weeks surrounding the initial NYC stay-at-home order, food service visitation proportion dropped substantially before partially recovering over the summer (Figure 5a).
• Changes in POI category visitation proportions varied by income percentile (Figure 6).
• Supermarket and deli visitation proportions generally increased by a greater amount for high-income CBGs (Figure 6).
• Fast-food visitation proportions increased for high-income CBGs and decreased for low-income CBGs (Figure 6).
• Clusters #0 and #2 maintained the overall highest supermarket and deli proportions whereas clusters #1 and #3 experienced the greatest initial increases (Figure 7).
• Clusters #0, #1, and #3 all temporarily increased fast-food proportions above pre-pandemic levels, with cluster #0 maintaining the highest overall value (Figure 7).

CDI

Figure 8 - Three-week average CDI at food locations in NYC over time (left). Three-week average CDI per capita by cluster (center) and by borough (right) over time.

• After the initial stay-at-home order in NYC, CDI across all categories decreased (Figure 8) consistent with findings by Verma et al. (2021).
• Rankings of CDI per capita by home CBG cluster did not significantly change.
• Manhattan and Staten Island switched relative rankings and followed different distributions (99% CI).

Visitation totals showed trends consistent with NYC survey data from May 2020 which reported that 64% of respondents shopped less frequently and 49% ate more packaged food compared to before the pandemic (CUNY School of Public Health, 2020); food retail visitation totals were 50% lower in May 2020 year-over-year, but formed a greater proportion.

Shoppers from low-income neighborhoods and clusters with higher rates of children and older residents had the greatest supermarket dependency. Low-income shoppers also reported the unavailability of essential and lower-priced food items at greater rates (CUNY Urban Food Policy Institute, 2020) despite having the smallest increases in supermarket dependency.

This suggested disparity in supermarket resiliency which exacerbated harm to high-poverty communities and individuals with diet-related diseases associated with food insecurity (Gundersen and Ziliak, 2015) who were already at greater risk from COVID-19 (Arasteh, 2021; CDC COVID-19 Response Team, 2020).

Fast-food dependency temporarily increased citywide as non-fast food restaurant visitation proportions declined. CUNY School of Public Health (2020) surveys found that compared to pre-pandemic behavior: 54% of respondents reported having a less healthy diet, and lower-income, Black, and Latinx households consumed more packaged food at higher rates. These reports were consistent with observed fast-food and deli visitation proportions in total and by clusters.

Clusters and boroughs with higher CDIs also included neighborhoods with the highest COVID-19 infections per capita (NYC Health, 2021). CDI model limitations prevented drawing policy recommendations specific to the food sector with confidence. However, CDI could potentially act as a broad diagnostic metric for outlier detection in future work.

Clusters #0 and #2 had the highest supermarket dependency, and thus were the most susceptible to food supply disruption when stay-at-home orders closed many food service options. This signaled that the greatest need to mitigate supermarket supply disruption was located in central and south Brooklyn, central and east Queens, and the Bronx. Expanding food supply in such neighborhoods may be the most effective direction of food insecurity reduction efforts.

After the initial stay-at-home order, most clusters and high-income neighborhoods increased their fast-food visitation proportions. These chain restaurants had the greatest financial resources to remain open. Meanwhile, over 1,000 NYC restaurants permanently closed with women and minority-owned businesses impacted disproportionately. Preserving greater nutritional choice to support stronger immune responses could be accomplished by ensuring immediate financial support to non-fast food services in future public health emergencies.

Conclusions

Survey data showed that shoppers from low-income and minority neighborhoods in NYC were more likely to experience supermarket food supply disruption, while mobility data showed that these same shoppers were also more dependent on supermarkets for a larger proportion of their diet.

Therefore, a comprehensive food resiliency strategy to reduce food insecurity and the resulting negative health outcomes during public health emergencies should:

• Expand food access in neighborhoods with the greatest supermarket dependency in order to maintain food supply
• Support non-fast food restaurants to ensure access to nutritious food
• Boost financial support to emergency food programs serving low-income neighborhoods where supermarket resiliency is disproportionate

The rise in food insecurity in NYC and its associated negative health outcomes require persistent monitoring for adverse long-term health impacts, recognition of the disparity in the city’s food resiliency system, and the collective support of New Yorkers to strengthen its weaknesses.

Credits

The CUNY Graduate School of Public Health & Health Policy (CUNY SPH) is committed to teaching, research and service that creates a healthier New York City and helps promote equitable, efficient and evidence-based solutions to pressing health problems facing cities around the world.

New York University's Center for Urban Science And Progress (CUSP) is an interdisciplinary research center dedicated to the application of science, technology, engineering, and mathematics in the service of urban communities across the globe.

Huy T. Vo is an assistant professor affiliated to both NYU CUSP and CUNY CCNY. His research interests involve big data analytics, large-scale visualization and high-performance computing.