Winnipeg Free Press - PRINT EDITION
Hunger amid the plenty
The inner city is a 'food desert' -- a nutritional nightmare
When Kelly Daniels said goodbye to greasy burgers and white pasta, his wallet suffered as hard a hit as his cholesterol.
The 44-year-old's doctor told him to change his eating habits or his high blood pressure and cholesterol would lead to Type 2 diabetes. Two months ago, Daniels tried to swap fast-food for vegetables and fruit and found healthy eating in Point Douglas doesn't come easy.
"Some of the fruit and vegetables aren't (fresh). They're starting to wilt away," said Daniels, who is on social assistance. "If I want really good fresh food I have to go to the more expensive stores."
Daniels lives in a "food desert" -- a neighbourhood where heart-healthy multi-grains and leafy greens are virtually absent, and a can of soda and bag of fat-laden potato chips is a cheap substitute for a balanced, nutritious meal.
The phenomenon has been well documented in many U.S. cities but new research has found access to affordable, healthy food may be limited in mid-sized Canadian cities like Winnipeg, London and Saskatoon.
Unlike Winnipeg's wealthy suburbs, there are few big-box grocery stores in the inner city, let alone ones with cases of pre-washed organic produce and a selection of multiple varieties of basic fruits and vegetables.
A trip to the grocery store for a big shop is a bus or taxi ride away, and many poor residents who can't afford to incur the added expense resort to buying food at a corner mart, where the "produce section" sometimes consists of four tomatoes, a few onions, and a wilted head of iceberg lettuce that is double the price you'd find in a suburban market.
The fallout has left the grocery wasteland struggling with growing rates of Type 2 diabetes and chronic illnesses such as heart disease that experts say will continue to get worse with rising food prices.
Critics say unless health or government officials step in with a sound strategy to make wholesome food available and cheap, the long-term cost to the health-care system could be astronomical.
It costs between $1,000 and $15,000 a year to care for a person with Type 2 diabetes, and about 80 per cent will die as a result of heart disease or stroke.
"We do see children here who are around the 18-year-old mark, and having to go onto insulin at that age is really tough," said Sheelagh Smith, a dietician with Health Action Centre on Elgin Avenue.
"We have a few people with Type one, but the bulk, the majority of people we see have Type 2 diabetes."
Sixty years ago, Canada's "food rules" suggested the average Canadian eat at least one serving of potatoes each day along with two servings of green vegetables.
Today, vegetables and whole grains are considered the pillars of food pyramid and a healthy diet - the green section of the Canada Food Guide rainbow is now the largest and recommends twice as many servings of fresh fruit and vegetables each day as in the 1950s.
Canadian cities have evolved just as much as nutrition guidelines, and University of Western Ontario geography professor Jason Gilliland thinks urban sprawl is part of the reason some inner-city residents live in health food vacuums.
Three years ago, Gilliland and his colleague, Kristian Larsen, decided to map the location of London's supermarkets in 1961 and 2005.
He found that the rise of the modern suburb caused a mass exodus of downtown dwellers and a migration of grocers out of the core. Big chain grocers bought acres of cheap land in the suburbs and erected massive box stores that can sell more for less. Gilliland said the void forces core area residents to turn to smaller convenience stores where they will pay 1.6 times more for their food.
"They're going to buy what they can afford and often that's the high fat, high sugar foods," he said. "This can contribute to an unhealthy diet which contributes to the risk of chronic illness like cardiovascular disease and Type 2 diabetes."
Gilliland found low-income residents of inner-city neighbourhoods have the poorest access to supermarkets - only one in five people in the inner-city have access to a grocery store.
Residents say that's the case in Point Douglas.
Four chain supermarkets are scattered on the edges of the neighbourhood - a Safeway on Mountain Avenue, Extra Foods and Safeway near the corner of Main Street and Inkster Boulevard and the California Fruit Market on Euclid Avenue.
Mom and pop grocers and convenience stores dot community streets in between. They charge more for their limited selection of produce since they can't compete with the volume of bigger stores. Gilliland said produce tends to sit longer in smaller stores because of the customer volume - which is likely why the Free Press saw wilted heads of iceberg lettuce, shriveled tomatoes and spinach two weeks past its expiry date in some of the stores it visited.
You can buy three bags of potato chips for $1.25 but a lone green pepper will run you $2. You won't find lean chicken breasts or ground beef either.
Corner marts and small grocers with deli sections typically stock the processed goods - hot dogs, bacon, sausages in plastic packages.
Several other area meat marts and bakeries have boarded up and gone out of business.
That leaves residents with a choice: buy cheap, unhealthy food for less at the convenience mart, or dip into their budget for taxi fare and bus money to make the trip to the bigger stores.
"Some of the folks say, sure I'd love fresh produce, but it's just not in my budget that I can spare the money," said Paul Chorney, spokesman for the Manitoba Food Charter. "It hasn't gotten enough attention. Everyone in our society deserves the right to access quality food."
Chorney said poverty drives food choices and that a single man or woman on social assistance simply can't afford the extra cost of eating healthily. He said recent estimates figure a family of four on social assistance spends more than a third of their income on food - about $608 a month. Chorney said based on the average cost of housing and food, a single man on welfare is already in the hole more than $200.
According to the latest Winnipeg community health survey, 41 per cent of Point Douglas residents are low-income - the highest incidence of any city district and double the Manitoba average.
On a blustery November day on Selkirk Avenue, Pam Sanderson and her daughter Desiree wait for the bus to go to Extra Foods.
Sanderson said it takes 15 minutes to get to the store by bus and sometimes as long as an hour to wait for a cab ride home.
She said she spends the extra money and makes the extra effort to buy apples, bananas and other healthy items for Desiree, who is pregnant.
"You get used to it," Sanderson said.
David Northcott, executive director of Winnipeg Harvest, said when low-income residents are tight on money, the first thing they dip into is the food budget. Food banks try to pick up some of the slack, but Northcott said Harvest relies on basic food items that can keep for long periods during winter.
"You can't store leafy lettuce very long, you can't store tomatoes very long," he said.
Of the 8.5 million pounds of food Harvest distributes each year, 1.2 million is produce that's grown within 100 kilometres of Winnipeg and donated by Peak of the Market. Northcott said most of the produce is root crops, like potatoes, onions and carrots available during the growing season.
Northcott called it a "Band-Aid solution" since families often can't afford to bulk shop for vegetables and fruit in the core.
When the temperatures dip below -20 C, he said, it isn't practical for families to spend extra money on bus fare or cab to get to a grocer that sells bulk items.
Michael Zacharias, an inner city resident, said he doesn't bother seeking out healthy alternatives when the selection of food in the neighbourhood is bleak. "Some places there's not very much, not very much at all, which is too bad," Zacharias said. "I'll eat a lost of fast food right now. I'll buy pizzas."
Complicating matters, is the rising cost of gas which has driven up the price of food. Experts worry rising fuel costs will drive up the price of food even more, and that low-income people will be left behind unless welfare rates are raised.
Daniels estimates eating more healthfully costs him $10 extra a week. And experts say food prices are going to get worse.
"A lot of the vegetables the price went up - a lot," Daniels said. "Potatoes, I used to pay 99 cents for a five pound bag. Now it's over $3 for a five pound bag. Everything else is going up too."
Chorney said there's a growing reliance on food banks but cautioned that is not a long-term solution. He said elected officials need to examine the consequences of ignoring the lack of food security among Winnipeg's poor and urged policy makers to intervene to stave off a potential health crisis.
"People are talking more and more about in Manitoba how much of the budget is eaten up by health care," he said. "How much of that is preventable if you start early with nutrition and nutrition education?"
The impact on the inner city's health is obvious.
A 2004 Winnipeg Regional Health Authority community survey found the core area has some of the worst health outcomes in Winnipeg, with higher rates of heart disease and stroke and diabetes than anywhere else in the city.
For every 1,000 people in Point Douglas 7.75 have Type 2 diabetes - twice as many as Winnipeg's south end. Downtown Winnipeg has a similarly high rate of Type 2, with 7.08 people per 1,000 affected with the condition.
And local health officials said there's no reason to believe those numbers are dropping.
Health care workers in the area can attest to the downwards spiral in the community's health.
Clinicians like Smith have seen the number of patients suffering from Type 2 diabetes triple in the last decade. Type 2 is a condition where the body makes insulin but can't use it properly. It can result from unhealthy eating habits and inactive lifestyle.
Smith said she's seeing clients as young as 18 with Type 2 and that diabetes outreach and counselling makes up the bulk of her work. She said some residents end up in a "feast and fast" situation, where they spend all their food money on take-out to fill up hungry bellies, and then have limited money left over to grocery shop.
"They go hungry. Then when they do get food, they feast: the cheque comes and that's when you order pizza or you go for fast food because it fills you up and you feel good and it tastes really good," Smith said.
Ideally, Smith would tell clients to load up on fruits and vegetables and buy fresh multigrains and milk. But that's not always realistic.
Instead, she looks for ways to modify healthy eating and exercise for people with limited means.
That means buying canned or frozen vegetables to last through the month, eating rye instead of whole wheat, and relying on diabetes medication to control insulin levels.
Smith said if they can't afford medication, she'll suggest a 10 minute walk around the house or the block before each meal to help lower control blood sugar.
"The big muscles in the legs can draw blood sugar without insulin, so it lowers the blood sugar without taking any extra medication," she said. "Most people can manage that."
Nina Kudriakowsky, a nutritionist with Mount Caramel Clinic, tells clients how to rinse the extra fat off ground beef or boil the skin off chicken legs if they can't afford to buy leaner cuts of meat. Pictures of simple, affordable meals are plastered on Kudriakowsky's office wall, along with diagrams that illustrate how many teaspoons of sugar lurk in a can of soda or piece of pie.
Kudriakowsky admits the job is frustrating, particularly since she said she's seen food insecurity get worse and more people step in her office suffering from diabetes.
One of the biggest challenges, she said, is getting area residents - many of whom struggle with mental illness or who are worried about the safety of their neighbourhood - to make their health a priority.
"I do have a high no-show rate," Kudriakowsky said.
Learning how to cook and recognize healthier foods may be part of the solution.
Smith said many area residents she meets grew up on white bread and white pasta, and simply aren't educated about alternatives.
"It's not just a matter of money. If you didn't grow up eating squash you don't even recognize them in the store and you don't know how to cook them," she said. "They're not going to be your favourites."
Community nutritionist Mary Jane Eason runs learning kitchens for aboriginal and refugee women to teach them how to pick and cook affordable, healthy food. Eason said she teaches students how to cook meals that can be made from local vegetables and whole foods - vegetables and homemade pizza to borscht and bannock.
Students learn how to turn cooking water into broth for homemade soup and stew. Eason said locally grown vegetables can be cheaper than buying processed fast food.
Small store owners don't stock much produce because of low turnover, but the idea is they might if residents demand it.
"Food may be very expensive for people living on low-income," Eason said. "Some of our students have trouble getting enough."
Adjusting to "Canadian" food is uncharted territory for some new immigrants, who may not be able to find items they used to purchase in Africa or the Middle East. Tete Diakite, who recently moved to Winnipeg from Ivory Coast, said she's learned to blend a traditional African diet with common Canadian fare.
"Sometimes there's no food from my country so I have to eat Canadian food," she said.
Neechi Foods on Dufferin Avenue encourages healthy eating through diabetes bingo and works with other community organizations to give out vouchers that can only be spent on healthy food. Carl Levasseur, company spokesman, said the vouchers can't be used for things like chips, pop or chocolate bars and staff try and dissuade customers from spending too much time in the junk food aisle. Sadly, Levasseur said food woes often take a backseat to chronic crime, alcoholism and drugs that grip the "gang banger" area to the detriment of community health.
"There's more to life than a bag of chips and a can of coke," he said. "(But) how do you initiate a change?"
Winnipeg's deteriorating core has long been a black mark for the city but Gilliland said something as simple as a supermarket is often a neglected key to reinvigorating and building a healthy community.
Putting an entertainment complex in the centre of the inner-city is an outdated way to revitalize a downtown, Gilliland said. Cities have moved beyond that and to get people living in the core or inner-city you need food systems and basic essentials to support a sustainable community.
"If you can't buy groceries - which you need everyday - then it's not really that liveable," Gilliland said.
Until that changes, Daniels is gearing up to walk to the store in the bitter cold this winter to prevent his health from deteriorating any further.
"I dress up warm," he chuckled. "Get your ski pants on."
Republished from the Winnipeg Free Press print edition January 11, 2009 A1
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