Using a social ecological model to explore upstream and downstream solutions to rural food access for the elderly

The Curated Food System: A Limiting Aspirational Vision of What Constitutes “Good” Food

“…This discourse focuses on consumers and medicalizes the food system as nutrition, diet, and individual behavior with an emphasis on solutions that call for education and/or policing personal conduct [ 35 ]. This discourse minimizes or ignores the contribution of the non-medical determinants of health to population health, (i.e., transportation, income, or neighborhood conditions), eventually asserting individual responsibility as the basis for good or poor health [ 36 , 37 , 38 ]. One underlying message is that having poor health results from “deviant” behavior, where those who suffer from diet-related diseases and sickness have failed to exhibit a sufficient degree of personal responsibility for their lives and more specifically what foods they eat [ 39 ].…”

“…Within this discourse, still failing to acknowledge non-medical determinants of health, the only other acceptable excuse for good versus bad food choices, falls back on socialization attributed to culture, family, or ethnicity [ 40 , 41 ]. Finally, in this narrative, food exists in service to the health of a body devoid of issues related to pleasure, appeal, social processes, and even temporal, geographical, and historical factors [ 36 , 37 , 42 ].…”

Shifting the gaze of the physician from the body to the body in a place: A qualitative analysis of a community-based photovoice approach to teaching place-health concepts to medical students

“…Places where people reside hold the key to the state of health and disease manifest within and on bodies. However, connecting downstream health problems (e.g., chronic diseases) to upstream issues and characteristics of communities is challenging for medical models, pedagogy, and tools [1,2] (Fig 1). Consequently physicians are rarely prepared to consider the social and systemic issues of a place because health models and medical training and practices either omit or fail to integrate place-health concepts that could explicate the structural, historical, and institutional features of places where patients reside [1][2][3][4][5][6][7][8].…”

“…A final principle of the place-health model are the Upstream and Downstream designations to the left of the diagram noting that a society can intentionally use its collective autonomy to work in any or all of these areas: 1) downstream, where illness already exist; 2) upstream on the structural issues including policies, systems, or regulations); or 3) furthest upstream on the cultural toolkit to explore and change the socially constructed, values, beliefs, and narratives that drive the assignment of meaning to group differences and other phenomena [2].…”

Place Effects and Chronic Disease Rates in a Rural State: Evidence from a Triangulation of Methods

“…Health advocates, community leaders, and researchers are worried that food environment problems, and poor diets in general, may be more severe in certain low income and rural American communities because these areas have limited access to affordable and nutritious foods. A primary concern is that some poor or rural areas do not have access to supermarkets, grocery stores, or other food retailers that offer the large variety of foods needed for a healthy diet (for example, fresh fruits and vegetables, whole grains, fresh dairy, and meat products) [ 1 , 2 , 3 , 4 ]. Instead, individuals in these areas may be more reliant on food retailers or fast food restaurants that only offer more limited varieties of foods.…”