Theoretical issues in the ‘food desert’ debate and ways forward

Food is essential to life—yet the spatial and economic configuration of the conventional food system does not meet nutritional needs and exacerbates issues of food insecurity. Relevant options for policy change have been explored in light of evaluations of geographic disparities in food access, but the dominant ‘food desert’ discourse often focuses uncritically on insufficient conceptions of access. Understanding the complexity of food deserts is important for moving into meaningful policy action. We present a theoretical position to inspire future empirical research. The ecological model recognizes both endogenous and built environment factors in shaping health. Interventions in the food environment, however, often concentrate exclusively on structural determinants of health (e.g. retail-based initiatives). Yet retail-based interventions are difficult to implement due to governance systems which limit the ability of government bodies to influence private retail development. As well, recognizing the complexity of debates over the influence of structure and agency, we apply structuration theory to food deserts. Behavioral economics further informs both structural and behavioral determinants of health. This approach sidesteps the issue of victim-blaming, as all consumers are viewed as ‘predictably irrational’ in decision-making. In combining these theories, we challenge methodological and theoretical assumptions by showing the complexity of food desert interventions. Policy recommendations focus on behavioral determinants of health and the opportunities for empowerment through local food systems. These recommendations recognize the limits of translating research into policy and in devising effective food based interventions, and are sensitive to social, economic, and political constraints uncovered throughout the paper.