s might also learn that the Supplemental Nutrition Assistance Program (SNAP) is accessed by many of his patients as a popular way to encourage purchasing fresh produce at nearby farmers’ markets.
In the Community
Dr D could delegate development of a nutrition component for his practice and open time in his schedule to concentrate on improving the diets of community members. Consistent with Opinion 11.1.1 in the AMA Code, he might do some reading so that he could apply best-available evidence to the health care services he provides.6 For example, Dr D might find data suggesting that people purchase the same types of foods regardless of where they shop7,8—whether in a corner store in a food desert like the one surrounding his practice or in a distant full-service grocery like the one in his neighborhood. Dr D might not favor building a full-service grocery store near his practice for other reasons. He might know that costs for building a full-service grocery store can exceed several hundred thousand dollars depending upon the business model selected.9 Some community activists might oppose full-service grocery stores because they fear negative effects of community development and gentrification. Finally, because corner stores can be viewed as a community resource and because they can be more successful in promoting nutritious foods than full-service grocery stores, Dr D might decide to help strengthen the existing business community by engaging corner store operators in an intervention to stock nutritious foods. Dr D might also know of an initiative to implement minimum stocking requirements for nutritious foods in stores that accepted SNAP and that merchants objected to these requirements because perishable items such as low-fat milk and fresh fruit were unpopular with consumers and often spoiled before they sold.10 To lessen the problem of spoilage, Dr D could encourage small store owners to stock whole grains, dried peas, dried beans, dried fruits, and nuts used in cooking traditional foods enjoyed by members of the community. He could also offer a small incentive to store owners who stop by his office to view the brief nutrition videos he offers his patients to promote consistent messaging in the community around these products.
A Way Forward
Improving the diets of people who live in food deserts is a complicated problem at the intersection of culture, education, and economics. Dr D will clearly need to collaborate with his patients and with leaders in the community to improve the availability and intake of nutritious foods. He should continue to learn more about making nutritious foods available in order to support initiatives based on scientific evidence and follow the opinions in the AMA Code, which provide a great deal of guidance related to this complicated problem.
- World Medical Association. WMA Declaration of Helsinki—ethical principles for medical research involving human subjects. https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/. Adopted June 1964. Accessed March 30, 2018.
American Medical Association. Opinion 8.11 Health promotion and preventive care. Code of Medical Ethics. https://www.ama-assn.org/delivering-care/health-promotion-and-preventive-care. Accessed April 30, 2018
American Medical Association. Opinion 1.1.3 Patient rights. Code of Medical Ethics. https://www.ama-assn.org/delivering-care/patient-rights. Accessed July 20, 2018.
American Medical Association. Opinion 10.5 Allied health professionals. Code of Medical Ethics. https://www.ama-assn.org/delivering-care/allied-health-professionals. Accessed April, 30 2018.
United States Department of Agriculture. Choose MyPlate. https://www.choosemyplate.gov/myplate. Accessed July 20, 2018.
American Medical Association. Opinion 11.1.1 Defining basic health care. Code of Medical Ethics. https://www.ama-assn.org/delivering-care/defining-basic-health-care. Accessed July 20, 2018.
- Walker RE, Keane CR, Burke JG. Disparities and access to healthy food in the United States: a review 